The Assembly met at 13:30 with the Llywydd (Elin Jones) in the Chair.

I call Members to order.

1. Questions to the Cabinet Secretary for Education

The first item on our agenda this afternoon is questions to the Cabinet Secretary for Education, and the first question, Joyce Watson.

Language and Communication Skills

Joyce Watson AC: 1. Beth y mae Llywodraeth Cymru'n ei wneud i hybu sgiliau iaith a chyfathrebu ymhlith disgyblion? OAQ51657

Kirsty Williams AC: Thank you, Joyce. Making sure that all learners develop excellent language and communication skills is a key part of our national mission for education in Wales. Our national literacy and numeracy programme, and its key policies, including the national literacy and numeracy framework, are targeting literacy interventions, supporting us to achieve this aim.

Joyce Watson AC: Iparticularly want to welcome the Time to Talk, Listen and Play campaign that was launched last week by Welsh Government. We all know that helping children have an early grasp of language is hugely important not only as they progress through school, but through life and into the workplace. I really am a huge supporter of this programme, because I think that initiatives like this,which help children to learn through what they regard as fun rather than an educational setting, really will give them the very best start in education. And I'd be interested, Cabinet Secretary, if you would give us an outturn and an update in 12 months' time to see how this programme has been effective.

Kirsty Williams AC: Thank you, Joyce. I'm glad that you like the Time to Talk campaign. I'm sure Members across the Chamber—well, hopefully, Members across the Chamber—will have seen the adverts on television and the materials that are available on social media. I think they're really engaging and fun, and they stress the importance to parents of the huge impact they can have by taking the time to talk to your children. To further strengthen early language and communication provision across Wales, we are investing £890,000 in foundation phase oracy programmes in 2017-18. That includes funding for the Time to Talk campaign, but also to fund the four regional educational consortia to work with schools to improve language development in the foundation phase.

David Melding AC: Cabinet Secretary, I have for many years been a member of the governing body of Meadowbank Special School, which is a school that delivers educational services for children with speech andlanguage learning difficulties. It's been at its site in Gabalfa for over 40 years and was foremost in developing best practice in this area, not least with its parents and teachers doing so much to establish Afasic in the 1970s. I am gravely worried about Afasic's closure in Wales and what's going to happen to those skills, information and support that's been made available to parents, to teachers. I do hope that your officials will be monitoring this very, very carefully, and perhaps talking to your colleagues in the Welsh Government to ensure that a way is found that essential infrastructure, like charities such as Afasic, are kept going, because it's a great service they provide.

Kirsty Williams AC: First of all, can I thank you, David, for your service as a governor of this school? Like you, I amdisappointed that Afasic Cymru trustees have decided to end their charitable status within Wales, although I understand they will continue to work at a UK level. I can give you an absolute assurance that I will be asking my officials to monitor very carefully the impact the closure of the charity will have, and to look to ways in which we can work across Government and across the voluntary sector,= to support those families whose children need additional help and support developing their language and communication skills.

Llyr Gruffydd AC: We know from figures provided by the Royal College of Speech and Language Therapists that over 50 per cent of children from socially deprived backgrounds may be starting school with impoverished communication, language and speech skills. Now, do you therefore share the Children's Commissioner for Wales's concerns that limiting the Government's childcare offer to only children of working parents, and not extending it to all children, actually risks widening that school-readiness gap amongst the socially deprived group that I referred to earlier?

Kirsty Williams AC: Llyr, I do recognise that these issues can be particularly acute in those communities and for families where there are high levels of social deprivation, which is why, as I said, we will be spending over £800,000 this year to develop our Time to Talk programme, so that we can work with families. Of course, the free childcare offer to working parents is just one of the schemesthat the Welsh Government runs, and you'll be aware of the work of Families First and Flying Start, which are particularly targeted interventions at those families and communities that need the help the most, which include a childcare element of that, as well as working alongside parents to help parents do the best job that they can do in encouraging these skills in their youngsters before they start formal education.

Crime and Violence in Schools

Gareth Bennett AC: 2. What steps is the Welsh Government taking to reduce the risk of crime and violence in schools? OAQ51666

Kirsty Williams AC: Thank you, Mr Bennett. Violence and aggression in schools, against teachers or pupils, is completely unacceptable. In order to tackle such violence and aggression, in and outside the classroom, working with stakeholders, we must first understand why children are demonstrating these behaviours. Otherwise we are simply treating the symptoms and not the underlying causes of such behaviour.

Gareth Bennett AC: Yes. Thanks for that answer. I agree that we do need to understand. We also perhaps need to pursue a standard approachto monitoring the level of violence so that at least we can also ascertain how much actually is going on, whichis something that the National Association of Schoolmasters Union of Women Teachers are currently calling for. So, would you be minded now to think abouta standard approach to monitoring levels of violence in schools?

Kirsty Williams AC: Thank you for that. I think it's, first of all, very important to recognise, as mentioned only recently in the latest chief inspector's report on the education system in Wales, that behaviour in schools is improving, and I would hate people to be listening to this question and thinking that we had a particularly acute problem. But clearly, as I said in my opening answer, any violence, whether that's directed towards fellow pupils or directed towards the staff of the school, is completelyunacceptable to me. Welsh Government has issued guidance to schools and local authorities around safe and effective interventions, and I am always willing to consider what more steps Welsh Government can take to address these issues. I want Welsh schools to be safe, secure and happy places of learning and work.

Nick Ramsay AC: Cabinet Secretary, last week, I visited Monmouth Comprehensive'sbrand new school building, which is still to be finishedadmittedly, in the town of Monmouth, and that building is a fantastic, creative space that's designed to be open, transparent andto reduce the chances of physical violence happening in that space as much as is possible. But, of course, buildings are only half the story, andwe know that violence takes many forms, particularly psychological violence, and in terms of schools and their pupils, cyber bullying. Can you update us on theWelsh Government's policesto tackle all forms of bullying, but specifically cyber bullying, which seems to be on the increase in certain areas?

Kirsty Williams AC: Thank you, Nick. I think school buildings can play a significant part in helping create that environment for our children, but we have to recognise that bullying can be a problem in all schools regardless of where they are and that can take many forms. We are updating our anti-bullying guidance 'Respecting Others', and the revised guidance will be published later this year. I have also undertaken to carry out a review into the specific issues around cyber bullying, online and internet social media safety, and will continue to work in this area. This is a relatively new aspect of bullying. In days gone past, children were able to return home to a safe space. These days, their mobile phones and devices allow a constant stream of chatter to continue, and we need to equip our children on how best to deal with that, how to behave responsiblyonline, and, if they come across behaviour that it is irresponsible, whom they can report that to, safe in the knowledgethat, having reported it, action will be taken to support them.

Questions Without Notice from Party Spokespeople

Questions now from the opposition party spokespeople. The Plaid Cymru spokesperson, Llyr Gruffydd.

Llyr Gruffydd AC: Thank you, Llywydd. It’s almost four and a half years now since the publication of Professor Sioned Davies’s report on the position of Welsh as a second language in English-medium schools in Wales. In that report, she made it entirely clear that it was the eleventh hour even then in terms of Welsh as a second language, and that attainment levels for pupils in that subject were lower than in any other subject. Had that been true about English or maths, I’m sure we would have long since seen a resolution to that problem. She concludes by saying that a change of direction is urgently required before it’s too late. So, can I askwhen the Minister intends the new combined qualification will be available for teaching in school?

Eluned Morgan AC: Thank you very much for the question. You will be aware that we have had the Donaldson review since then and that we need to consider the changes in the context of Donaldson. So, can I make it clear that I am not prepared to wait until Donaldson is in place? I think that this is something that we have to pursue now and I have asked, today as it happens, my officials to arrange a symposium to bring experts in the area together to discuss the best way for us to teach a second language. I don’t think this is a problem just in terms of the Welsh language, but it is a problem with other languages as well. My focus, of course, is on the Welsh language. I can tell you that it is a fact that I will be concentrating particularly on this issue of increasing the number of people who can speak Welsh by the end of their school years. The intention, of course, is that 70 per cent of people will be able to speak some Welsh by 2050 when they leave school. So, we do have a long way to go.

Llyr Gruffydd AC: Thank you very much. I welcome that answer: that you won’t wait until Donaldson is in place because we know it will be 2025 by the time everyone has access to the new curriculum, and that’s potentially another generation of Welsh speakers lost. Can I ask you what consideration will be given to piloting or trialling this new model in specific areas in terms of combined qualification? The danger is that it will take two or three years, if I know how Governments usually operate, when, in fact, there is an appropriate workforce and a willingness in some parts of Wales to turn this around very quickly.

Eluned Morgan AC: Well, to begin with, we need to look at what is in place today. I think that we do have to look at further resources for teachers who are teaching Welsh as a second language, and I have been talking directly with teachers who are out there in the classrooms and asking them precisely what they would like to see as forms of assistance. So, my officials are looking into what we can do to assist now, this year, and I have had a conversation with the BBC to see whether they would be willing to assist in this area also, because I think that we could do more visually in terms of teaching children in the classroom. So, actions are being taken, but I must say that I do emphasise that I think we can’t afford to lose another generation. I agree on that.

Llyr Gruffydd AC: I’m sure you’ll understand the frustration, because hearing a Minister say that we’ll have to see what the situation is today, a full four and a half years after a report stated that action was urgently needed, is a cause of frustration. I do have to make that point.
Now, of course, it’s not possible to move forward meaningfully to share the target that I’m sure we share in terms of a million Welsh speakers and the role of the education system in that unless the appropriate workforce is in place to provide the necessary education. I will refer to the Aled Roberts review of Welsh in education strategic plans, which said quite clearly that,
'We must ask ourselves, what purpose is there to plan for substantial growth for Welsh-medium and bilingual education...without urgent decisions being made to train more new teachers who speak Welsh. This is particularly the case within the secondary sector.'
Now, we know that 6 per cent of the education workforce speak Welsh but don’t teach through the medium of Welsh. So, what is this Welsh Government going to do to bring that group of educators into play in this area? We also know that 80 per cent of students studying PGCE courses have come through the education system in Wales, and if they haven’t been part of bilingual education then they should have had 10 years of Welsh lessons. Okay, there are deficiencies in terms of Welsh as a second language, but there should be a foundation there to develop a qualified workforce in terms of Welsh-medium education. So, can I ask how you’re going to use and build on those linguistic skills and when will we see a Welsh-medium education workforce plan developed and implemented? Without it, we’ve no chance of reaching that million Welsh speakers.

Eluned Morgan AC: Thank you. We do have a workforce plan in place and we have made it entirely clear how many teachers will be needed over the coming years. My hope currently is to ensure that people are aware that there are £5,000 available in additionif they show an interest in teaching through the medium of Welsh. We must make sure that people are aware of this because now is the time when people are starting to think about what they’re going to do in September. I have asked my officials—. You’ve pressed on the two buttons that I have been pressing. There are two things that are most important to me: they are getting the workforce right—because if we don’t get that right from the beginning, that is going to cause me concern—and, secondly, the need for us to think about what we need to do improve teaching Welsh as a second language.
So, I acknowledge that 6 per cent of people in the workforce currently—perhaps we could have discussions with them. So, that is something that we are paying attention to currently. So, we are very aware that we do need to move on this and I have requested my officials to give me a monthly report about the situation in terms of how many people have applied to go to these colleges, so that we are sure that we’re on the right track.

The Conservatives' spokesperson, Darren Millar.

Darren Millar AC: Diolch, Llywydd. Cabinet Secretary, in 2015 when the new Wales-only GCSE qualifications were being mooted and going to be introduced, my colleague Angela Burns, the then shadow Minister for the education portfolio, said that it was a short-sighted decision and that there would be adverse consequences for learners. It's now 2018, and I'm afraid that some of our concerns are materialising.Morethan half of pupils who took the new maths GCSEs got aDor below, according to the results that were published earlier this month. Do you now accept, andwould you agree with our assessment, that your predecessor's decision to introduce these newqualifications was a mistake?

Kirsty Williams AC: Darren, for pupils and teachers currently in the system, we have to deal with the reality of today, as do I. I have made it very clear in this Chamber, time and time again, that I want to see education raise standards for all of our children, including bridging the attainment gap between those pupils who are less well-off and ensuring that oureducation system is a source of nationalpride and confidence, and by improving GCSE results,that's one of the waysin whichwe can do that. I've been clear, since coming into office, that we can do better, so with regard to mathematics, for instance, we have set up the new national network of excellence for mathematics, so that we can improve the teaching of mathematics across the country, and also to ensure that, for instance, with regard toearly entry, which we know in some cases can be detrimental, it should only be used in schools for those pupils who are in a position to fulfil theirmaximum potential ratherthan being sent in early for an exam and not achieve the results that they are capable of achieving after a full teaching of the course.

Darren Millar AC: Those words will be no comfortwhatsoever to those learners who got lower grades than they would have done sitting the previous GCSEs. We also warned, of course, that the new GCSEswould confuse employers and were likely to be less accepted by them than werequalifications from other parts of the UK, and, of course, we'vebeen right on thatcount as well. We know that withapplications forapprenticeships in England, which require maths GCSE and English tests—somepeople are having to resit English GCSEs,because the Welsh GCSE is not considered to be of equalvalue when trying to access someparticular apprenticeships. That's unacceptableand it's youngpeople who are paying the pricebecause of this sop to want to go after Wales-only qualifications, and it's disadvantaging our children and young people.
What are you going to do to ensure that students, learners and people who want to go on to professions, where there arecertain entry requirements, and apprenticeships where there are certain entry requirements, and wherethe English GCSEs that we have in Wales and the Maths GCSEs that we have in Wales are not recognised—what are you going to do toprevent ourchildren and young people from having another barrier to climb over by having toresit GCSEs,because that's what's happening according to the evidence, in order to get there?

Kirsty Williams AC: Let me just be absolutely clear: the Member can simply not make the assumption that those children would have done better under the old GCSE examination system. I make no apologies, Darren—and I'm surprised that you don't agree—for wanting greater rigour in our exam system, and if maths exams are introducing greater rigour, then that is something that we should be proud of, rather than dumbing down our exam system. Let me be absolutely clear as well—because you are doing a disservice to the children and the teachers of Wales by somehow peddling a myth that our examinations are not comparable to examinations in the rest of the United Kingdom. There is no evidence at all that you can bring forward to this Chamber to back that up. Our examinations, overseen by the independent body of Qualifications Wales, and modified and monitored across UK bodies, are of equal worth to anybody else's, and to suggest otherwise in this National Assembly and not come forward with any hard evidence, you are doing a disservice to those children who have got those exams.

Darren Millar AC: This isn't just me saying this—this is employers who are voting with their decisions not to take on young people from Wales who have sat some of these qualifications. This is universities—top universities around the UK—who are saying, 'We don't accept the GCSE in numeracy for people from Wales as being equivalent to GCSE maths', which, of course, is what Qualifications Wales are telling us. This is universities who are not accepting the Welsh baccalaureate as being of equal value to the A-levels that children and young people sit elsewhere across the country. So, you can get up and you can posture all you like, Cabinet Secretary—the reality is that these are clearly not of equal value in the market where they need to be of equal value, and that is in terms of helping people to get jobs and to get into those HE courses and onto the FE courses that they need to. And not only that, but one of the reasons that teachers tell me and the pupils tell me that they're getting lower grades is because, of course, they've now got two sets of exams to sit when it comes to mathematics—a numeracy one and a maths one. That is causing problems with timetabling, it's causing problems that are putting a squeeze on some of those other subjects, and it's dragging down their results. Now, I notice that last week it was revealed that there's an expert who you are employing to sell these new qualifications to GCSEs around the country, wasting taxpayers' money, because you are pursuing this differential approach. What action are you going to take to tell us how much that is costing and what has been wasted on these so far, and when are you going to abandon this ludicrous project?

Kirsty Williams AC: It is absolutely incredible that the Member would suggest that anybody in this Chamber would oversee an examination system that would do our children down. Darren, you and I both have children in this system. Do you think for one minute that even as a mother, let alone the Cabinet Secretary for Education, I would stand here and let my child or anybody else's child undertake a qualification that was of less value? You have no evidence that you can bring to this Chamber that would back up your assertion that our GCSEs are not of equal value. And I'm surprised—I am very surprised that the Conservatives want to abandon GCSE numeracy, because usually they're here in this Chamber saying that we need to ensure that children have the skills that workers and business are asking for, and that practical application of mathematics that is tested in the GCSE numeracy examination is exactly the kind of skill that I want to see Welsh young people learning.
And let me put the Member straight, Presiding Officer: I am not employing anyone to go around selling these qualifications. QualificationsWales, which is an independent body, will be employing a person to ensure that universities across the United Kingdom are left in no doubt of the rigour of our examination system, and I would say that any university that turns down the opportunity of taking on a Welsh student, or any employer that turns down the opportunity of taking on a Welsh young person, they are missing out, because our young people are as good as those anywhere else.

UKIP spokesperson, Michelle Brown.

Michelle Brown AC: Thank you, Presiding Officer. In April last year, a survey conducted by the Education Workforce Council at your behest found that 90 per cent of teachers said they were unable to manage their workload. One of the teaching unions said that the survey showed that many in the teaching professionare at breaking point. At the time, you said that, as a priority, you were determined to tackle the long-running issue ofworkload and ensuring that teachers have the space and time to teach to the best of their ability.For the sake of the teaching staff, it's vital that something visible is done to address this. What's your assessment of progress on reducing teacher workload so far, Cabinet Secretary?

Kirsty Williams AC: Well, the Member is right to say that workload is a continuing concern for the workforce and, indeed, for me. Workload concerns vary greatly across the education family, however. Different issues and priorities are raised depending on a variety of factors, including which school phase somebody finds themself working in, rurality, deprivation, subject area or the role that they have within an individual school, as well as individual operating practices demanded or deemed by the leaders of those schools. Our aim is to build capacity and reduce excessive workload leading to improved standards for our children but also a better ability for teachers to manage their workload.

Michelle Brown AC: Thank you for that answer, Cabinet Secretary. One way to reduce teacher workload, apart from reducing the amount of paperwork they're required to do, which I didn't hear you mention, would be to reduce class sizes. This is something that I feel quite strongly about. That would be to the benefit of both teachers and pupils and go a long way to delivering the world-class education that I know our teachers are capable of providing if they're allowed to. Do you agree with me? And, if so, what measures have you implemented to reduce class sizes?

Kirsty Williams AC: On the issue of paperwork, we are carrying out a bureaucracy project to look to see what paperwork we can take away from teachers. We're employing business managers via our pilots so that those tasks that are not related to teaching and learning can be taken on by another professional in the school, and we have sent out a myth-busting document that demonstrates quite clearly our expectations of the teachers.
Now, for the first time ever, there is something that Michelle Brown has said that I do agree with. I agree with you that class sizes are incredibly important, and that's why we have made resources available to local authorities, both capital and revenue, to help them reduce class sizes in the areas of education where we know that that policy will have the biggest impact, and those are our youngest children and classes that have high levels of deprivation or high levels of children who do not have English as their first language. I would be very happy to write to the Member to provide her with an update of the plans that local authorities in north Wales have come forward with, if she's interested.

Michelle Brown AC: I would be very interested, Cabinet Secretary. Thank you for that answer.
Moving on, local authorities are under increasing pressure from Welsh Government to set aside land for housing, and new housing is being built across Wales in anticipation of a rising population. Welsh Government's keen to develop Wales and attract people in. I have no problem with that. What I want to ask, though, is: in light of the likely rising population in Wales, what plans have you put in place to ensure that there are sufficient places in schools to properly educate additional children?

Kirsty Williams AC: The planning of school places is primarily the responsibility of individual local authorities, who I would expect would be able to ensure that when dealing with, for instance, new housing developments, they have taken into consideration the ability of people who may live in those areas to be able to respond to educational needs. If the Member has any examples where she feels that that is not happening, I'd be very interested to hear from her because we can take that up with individual local authorities.
I recently had the privilege of opening a new school in the Newport area, built in an area of the city that is experiencing a great deal of house building, and in that school, the school is going to grow as the community grows. So, they have an intake of reception and year 1, and as the community grows around it, there are spaces available in that school, and that's an example of a local authority really having some forethought about how they plan for increased housing and demand on education in their area.

Sex and Relationship Education

Julie Morgan AC: 3. What plans does the Cabinet Secretary have to improve sex and relationship education for pupils? OAQ51679

Kirsty Williams AC: Thank you very much, Julie. I am committed to improving sex and relationship education in schools in a variety of ways. That is why I have given £50,000, for instance, to Welsh Women’s Aid to develop SRE resources. I am also considering how the recommendations of the SRE expert panel can inform plans to improve SRE delivery now and in the future.

Julie Morgan AC: I thank the Cabinet Secretary for that response, and I welcome the SRE expert panel report and look forward to its recommendations being put in place.
At the 'State of Child Health' in Waleslaunch last week, a group of young people were saying that their experience of SRE in schools is very patchy, and that, in some schools, it's very limited, especially in Catholic schools, and they raised the issue that nearly all the teachers delivering the subject are not specifically trained to do so. And, of course, we did have the Terrence Higgins Trust report in 2016, which said that the way it was taught was not inclusive at all and didn't talk about LGBT relationships, didn't talk about consent and didn't talk about gender identity.
So, how will the Cabinet Secretary address the wide variation of provision that there is at the moment? How will she address the fact that the teachers are not trained, and how will she ensure that this subject is much more inclusive in the future?

Kirsty Williams AC: Thank you, Julie. Any Member who spends any time visiting children and asking them about their current experiences of education in PSE lessons will have heard a similar complaint. Currently, what we're delivering for children in terms of sex and relationship education is not what they want and is not equipping them, in many cases, with theinformation that they need.
You're right to say that, in many cases, this is not about a lack of resources, but it's about, sometimes, a lack of confidence and understanding amongst some of the teaching workforce who are expected to deliver some of these lessons. I'm afraid to say that, with regard to inclusive sex and relationship education, there are still some professionals who are still very wary of talking about LGBT issues because of legislation from previous Governments in another place many decades ago, and that legacy, I'm afraid, is still with us in some of our schools.
I'm absolutely committed to using the expert panel to ensure that, going forward, we have sex and relationshipeducation thatis truly inclusive and will be delivered by a profession that feels well-equipped and confident in their ability to deliver those lessons. Crucially, the Member will be aware, Presiding Officer, that health and well-being is one of the six areas of learning and experience in our new curriculum, and we will, as a nation, have to develop the expertise of a new suite of professionals who will be in a position to deliver that new part of our curriculum. In years gone by, we've trained geography teachers and chemistry teachers and physics teachers, but thisis an area of the curriculum where we haven't been able to create that specific career pathway, and I know that the curriculum will be the perfect nudge that we need to change that, going forward, so thatchildren will havea better experience.

Mark Isherwood AC: You will recall in the last Assembly the three opposition parties then worked together to secure concessions from theWelsh Government. We took them to the line over the Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015, and that included a commitment from the Welsh Government, alongside support from Peter Black from your party then and Jocelyn Davies from Plaid Cymru and myself, to involve stakeholders from the violence against women sector in developing the healthy relationship education in the curriculum to be followed by all schools.
During that time, I think both you and I referred to Hafan Cymru's Spectrum project to educate pupils in schools and train teachers in schools about healthy relationships. How, therefore, will you be giving your support to the campaign being launched by Hafan Cymru on 3 February regarding healthy relationships, as they say it will support vulnerable men, women and children, help them deal with loneliness and isolation through their Men's Sheds project and, critically, teach children about healthy relationships and domestic abuse through their Spectrum project?

Kirsty Williams AC: Thank you, Mark. I want to take this opportunity to recognise your personal commitment to this agenda. You will have heard in my answer to Julie Morgan that I'm being as good as my word in opposition as I am in Government in the fact that we have given a grant to Welsh Women's Aid to help develop resources for schools with regard to what safe, respectful and nurturing relationships look like. And I'm glad that we have a variety of voluntary organisations that are willing to work alongside us on this agenda.
The health and well-being area of learning and experience working group that is looking to develop this is taking evidence and views from a wide range of stakeholders outside of the education system to inform their work. And, with regard to the Men's Sheds project, I'm very proud, in my Assembly Member capacity, to have a good working relationship with the shed in Knighton and the shed in Llandrindod Wells, which I officially opened, because I recognise that sometimes, for men, some of these issues around mental health and relationships, they find difficult to talk about. Men's Sheds, I think, is a very worthwhile project, creating that safe space for men to talk about some of these issues that the male stiff upper lip sometimes prevents them from talking about.

Female Role Models

Jayne Bryant AC: 4. How is the Welsh Government encouraging schools to promote female role models in the classroom? OAQ51673

Kirsty Williams AC: Thank you, Jayne. We want our young people to be ethical, informed citizens of Wales and the world, and healthy, confident individuals, ready to lead fulfilling lives as valued members of society. That means promoting positive female and male role models in the classroom.

Jayne Bryant AC: Thank you, Cabinet Secretary. With the centenary of the end of world war one and women getting the vote over 30, it's vital that we share with boys and girls the contributions of so many women before us. Yesterday, I was proud to unveil a blue plaque for Annie Mistrickin Newport—a nurse who was on the front line, who put her own life at risk to care for and treat wounded soldiers in world war one. She was awarded the highest honour by the French Government for bravery. Pupils from St Woolos Primary School were there at the unveiling to hear about a local woman who was so remarkable, yet nearly lost from history. What support is the Welsh Government providing to schools to ensure that all pupils across the curriculum learn about women, past and present, who play such an important role and, where possible, linking schools with local women and events to bring them to life for a new generation?

Kirsty Williams AC: Thank you, Jayne. I was delighted to listen to reports on the media yesterday of the unveiling of the plaque. It's sad that it's taken such a long time, really, for this amazing woman to be recognised by her home community when the French Government, over many, many years, at the time, recognised her immense contribution.
There is a variety of ways in which we work with a number of organisations to ensure that children in our schools have access to a wide range of opportunities to learn about women from history, and indeed their own local history. So, for instance, I'm aware that, just next month, the soroptimists of Monmouthshire are putting on an event at King Henry VIII Comprehensive Schoolin Abergavenny where they will be talking about women in science and how we can encourage more girls in primary and secondary schools to study science. So, there's a whole variety of work going on to ensure that we have positive role models for all of our children in school, and we recognise the contribution that Welsh men and women have made, not only to their local history, but, in the case of Annie, to a bigger cause.

Suzy Davies AC: Well, I'm more than happy to cite Amy Dillwyn from my region as a dead role model—that's not always the most useful role model, though. One of the recommendations from the'Talented Women for aSuccessful Wales' reportis that we should find imaginative initiatives to challenge gender stereotypes and encourage girls and boys to consider non-traditional occupations. When do you expect to be able to give us some working examples of role models who have been persuaded to go into schools, and how schools themselves have identified those—it could be women, but it could be men as well, I suppose—so that we know what a good role model might look like? Thank you.

Kirsty Williams AC: I think, Suzy, you're absolutely right: we need to really challenge some stereotypical images that people have. That's why I'm aware that my Cabinet colleague, Julie James, only this week was involved in the This is Melaunch at a local college, really challenging what it means to be male or female and what that might mean in terms of the expectations you have of yourself, or that your peers and your community might have of you.
It's also really important in terms of Careers Wales and the offer that Careers Wales put into schools to help inform children when they're taking individual subject choices about what that means for their career going forward. So, I know that Careers Wales activities and services do challenge gender stereotypes, and they do work to facilitate education and business links, for instance, through their exchange programmes, so that people have a wide variety of opportunities to explore what they may want to become when they leave school.

Siân Gwenllian AC: This place was an excellent role model for gender equality, but since 2003, the situation has changed and has moved backwards. I'd like your opinion on the principle of introducing legislation to create equality in terms of representatives in the National Assembly as a means of leading to equality in other areas, including in our schools and education more generally.

Kirsty Williams AC: Perhaps there's one silver lining to the predicament I find myself in: at least the Welsh Liberal Democratscan claim 100 per centfemale representation in this particular Assembly term. [Laughter.] Although, I must admit that's not a particular silver lining I would have welcomed.
I have always, throughout my political career, paid tribute to other political parties that, I believe, took very brave steps to ensure good gender representation in this place. I have to admit that it's a battle that I was never able to win when I was leader of my own political party. I'm a firm believer: unless you can see it, you can never hope to become it.
But, from my perspective in education, what's really important to me is that we, via our existing PSE curriculum and our new curriculum, give young women the opportunity to learn about the political process, to understand how that political process works, and to encourage in them a desire to want to contribute to it, as campaigners and activists in their own communities as well as formal politicians who might seek to serve on councils, in Assemblies or in Parliaments.

Access to Apprenticeships

Rhun ap Iorwerth AC: 5. Will the Cabinet Secretary make a statement on the impact of travel costs on access to apprenticeships? OAQ51670

Eluned Morgan AC: We take the welfare of apprentices seriously and we do recognise that travel costs can be a barrier for young apprentices, though this is an employed programme. We will be looking at what opportunities are available to remove any access barriers to the programme, and that will include travel costs.

Rhun ap Iorwerth AC: I’m very enthusiastic for there to be far clearer communication with young people at 16 years of age that they should consider apprenticeships as an alternative option. A constituent contacted me recently who was also very supportive of apprenticeships, and both his sons are currently on apprenticeships at the moment. But, he is concerned about this barrier in terms of high travel costs for those attending apprenticeships, and that that is particularly acute in rural areas where, of course, the workplace can be a very long way away. What special consideration can the Government give in light of the answer that we’ve heard from you this afternoon to very specific considerations for rural areas, where the workplace for an apprentice isn’t on his or her doorstep and can be a very long way away?

Eluned Morgan AC: May I say that I have looked into this issue? One of the problems is that because this is an area where we do give additional funding, that could be seen as a taxable benefit, and that then creates a problem because this assistance isn’t available to all. So, what we don’t want to see is a situation where money is taken away from them because we are giving them this benefit. So, it is more complicated than you might see at first glance.
Of course, we have had this mytravelpass, which gives a third off ticket prices for people who are aged 16 to 18, and that is currently being evaluated. I believe that that takes us in the right direction. However, I do understand that this is a problem for people living in rural areas where distances are a factor. So, we are looking into this and we are considering now what the solution is and how we should respond in terms of mytravelpass.

Mohammad Asghar (Oscar) AC: Cabinet Secretary, affordable transport is vital if young people are to be able to access education and training to obtain the skills our economy needs. The National Union of Students points out that some apprentices are paying 20 per cent of their income on travel and have called for the introduction of an apprentice travel card. I just heard from the Minister there about taxable benefit. I think that's not possible, because the children are always exempt from anything. So why is this? I think don't mix oranges with apples here.
Does the Cabinet Secretary agree that providing all 16 to 20-year-olds in Wales with a card offering a free bus pass would remove a huge barrier to young people accessing education, training and job opportunities, which our side of the Chamber has been asking for for many, many years? You're not even listening.

Eluned Morgan AC: Can I point out that, when you're on an apprenticeship course, you actually receive an income, and any income is, theoretically, taxable? So, we have got to be sensitive. We have been looking at what is possible, because it has been recognised as a taxable benefit. So, we're not comparing apples with oranges, we're actually making sure that these people don't get into more trouble.
I do think that what we need to do is to make sure that we put pressure, sometimes, on some of the bus companies. If you look in Cardiff, for example, the Iff card, there are discounts for 16 to 18-year-olds, so it is possible for that to happen. But already—if it's available to everyone, it's not a problem. It's when you start just giving it to special circumstances, that's when it creates a problem.

Further Education

Bethan Sayed AC: 6. Will the Cabinet Secretary outline plans to improve further education to support more people to gain qualifications in Wales? OAQ51681

Eluned Morgan AC: 'Taking Wales Forward', the Government's programme to 2021, clearly sets out our belief that the future prosperity and stability of our nation depends on the skills and values of our people. The Government recognises that further education learning, whether lifelong, part-time, or work based, is essential for individual and national prosperity.

Bethan Sayed AC: Thank you. Page 8 of 'Education in Wales' discusses the need for a strong commitment to effective collaboration as well as the integration of services where appropriate. Could you expand on what the opportunities to collaborate more effectively are in terms of colleges and schools? For example, the Welsh Government used to fund 14 to 19-year-old fora through the medium of Welsh, and this did try and promote collaboration between those sectors specifically. Are there any similar proposals in the pipeline, and could you tell us about those, if there are?

Eluned Morgan AC: It is important that we do see better collaboration between schools and further education. Now, we are looking at how we can see that collaboration through the post-compulsory education and training changes that we will see in future. We'll take competition out of the system because that can create problems at present. But I do think it is worth stating that there is quite a high level of success in FE at present. About 86 per cent of people do succeed in the field of FE, so that is quite an important step. What we do need is to go even further and push those standards even higher and constantly.

Support for School Governors

Jenny Rathbone AC: 7. What support will the Welsh Government provide for school governors in the next financial year? OAQ51650

Kirsty Williams AC: The Welsh Government will support governors by working with the regional consortia to strengthen the national model for regional working and we will also respond to the consultation on school governance with proposals for a revised and simplified regulatory framework.

Jenny Rathbone AC: You'll be aware, Cabinet Secretary, that over £0.25 million that used to go to Governors Wales is not going to be forthcoming in the next financial year, and they're meeting on 16 February to decide whether to close their doors.
Governors Cardiff is continuing to exist, with a £50 levy per school, and that may be possible in an urban area where schools are relatively close together, but, given that school governors are the ultimate active citizens—they're not being paid for carrying out their duties—what are the opportunities now for governors to all get up to speed? I was looking at the Central South Consortium, and there's nothing there in terms of explaining to governors what their role is in ensuring that their priorities are met. I'm aware that Cardiff Council has cut their governor support from four officers to two, so it would be useful to know how you think governors are going to be supported to carry out their quite complex role.

Kirsty Williams AC: I thank the Member for that. I've been very clear that, in order to protect front-line delivery for schools, I am prepared to make difficult decisions, and, in that regard, as governor support is already provided through local authorities and regional consortia, as the Member has said, we will be ending the grant to Governors Wales.
We're not seeking to replace or replicate the support previously provided by Governors Wales as we believe that many of the services offered, as I said, are already duplicated by local authorities and the regional consortia. I need to make it clearthat of the approximately 21,000 governors that we have in Wales—and, Jenny, you're absolutely right, they are the ultimate in active citizens—only 2,000 of those governors were actually on the Governors Wales mailing list, receiving information from Governors Wales, and, when Welsh Government undertook a review in 2014-15 of Governors Wales activity and support, we identified, for instance, only 10 per cent of governors participating in that review used to contact the helpline that Governors Wales operated. In these difficult times, we can't afford the duplication of service, and we'll be working with the revised regional model and revised expectations of what regional consortia need to support and recognise that, in many instances, governing bodies and governors seek support from their local authorities.

And finally, question 8—Hefin David.

'Successful Futures'

Hefin David AC: 8. What is the Cabinet Secretary doing to prepare the post-16 education sector in Wales for the implementation of the recommendations included in the 'Successful Futures' report? OAQ51676

Eluned Morgan AC: Professor Donaldson's review, 'Successful Futures', had radical and wide-ranging implications for the education system in Wales. We've been working with a range of stakeholders to develop the plan and overall timeline. The focus is on the essential and employability skills young people need in their future lives.

Hefin David AC: Further education should be included in the design and development of the curriculum. The Baker clause has recently come into effect in England, whereby schools are required to let FE providers advertise their services to pupils in years 8 to 13, making learners aware of the range of options available to them after they leave compulsory education. With the significant reforms under way to the curriculum, and particularly governance of post-16 education as well, do we in Wales need to consider a similar mechanism in order to prepare pupils for the transition between schools and FE?

Eluned Morgan AC: Well, 'Successful Futures' doesn't specifically mention post-16 learners, but I do take the point that, actually, it is important that there is a relationship and people understand the continuity that is necessary between school and further education. So, what we've asked is we've asked Colegau Cymru to come up with a set of recommendations in terms of what FE can do in terms of developing the new curriculum, but I think the other point is that we do need to make sure that children in school are aware of all the opportunities available to them and that the academic route is not necessarily right for everyone, and we need to make sure that perhaps we have a more objective possibility within schools in terms of allowing individuals—making it individual-centred rather than a system where there is an encouragement to stay on, necessarily, in school, which is not right for every pupil at sixth form.

Thank you to the Minister and the Cabinet Secretary.

2. Questions to the Cabinet Secretary for Health and Social Services

The next item is questions to the Cabinet Secretary for Health and Social Services. The first question is from Jane Hutt.

The Health of the Nation

Jane Hutt AC: 1. Will the Cabinet Secretary make a statement on the Chief Medical Officer’s latest report on the health of the nation? OAQ51659

Vaughan Gething AC: Thank you for the question. I welcome the chief medical officer's report, which was launched today. It has a particular focus on harm from gambling as an emerging public health issue, and I look forward to making a full statement on the report and its recommendations next week.

Jane Hutt AC: Thank you, Cabinet Secretary. I look forward alsoto looking at the latest CMOreport out today, but I'd like to refer to the last report, 'Rebalancing healthcare: Working in partnership to reduce social inequity', which draws attention to a major global theme that many health problems demonstrate a strong social gradient, and there's a higher prevalence of illness and early death in more economically disadvantaged groups and areas. Indeed, Professor Marmot, earlier this week, I heard was emphasising this point. I know that you've met Professor Marmot in a former capacity in terms of your role tackling poverty in Wales. Of equal relevance, of course, for the Welsh Government is the inverse care law, the principle that the availability of good medical or social care tends to vary inversely with the needs of the population served. This principle was proposed by south Wales GP Dr Julian Tudor Hart, and has been widely adopted as a steer for health policy. Can the Cabinet Secretary identify how he is addressing the need to reduce social inequity in health status and health provision in Wales?

Vaughan Gething AC: I thank the Member for highlighting a hugely important issue for the future of healthcare in Wales and beyond today. This, of course, is a key aspectof prudent healthcare, which my immediate predecessor outlined, and that's continuing throughthe service. Prudent healthcareis a key aspect when looking at, for example, the NHS Wales Awards; we look for evidence of a prudent approach to running and delivering services. It's also been highlighted and reinforcedin the recent parliamentary review as a key driver for our system. There are some positive things to look at here in Wales; it's not just a counsel of helplessness. If we look at Aneurin Bevan Local Health Board and Cwm Taf Local Health Board, they've both had inverse care law programmes, deliberately going out to communities with the greatest level of risk, those people who don't engage with their own health, and the results are really positive thus far as well. I think in a previous appearance before the health and social care committee—it's not called that; it's still got sport in its title—I'd indicated that I'd write to them with an update on the initial evaluation from those two programmes from both vice-chairs. I'd be happy to share that with all Members, becauseit does show that that practical approach is starting to have an impact. There are lessons to learn from that approach and others for our whole service to adopt across the country.

David Melding AC: Cabinet Secretary, such is the plentitude, if I can put it that way, of gambling opportunitiesthat we hear today that 16 per cent of children aged 11 to 15 gambled in the past week. I do find that quite shocking. I should say that I do gamble occasionally. But we've got a real problem with gambling addiction, and now we hear from the chief medical officer that it is one of the major public health concerns that we face. Are you likely to review the current position of the Welsh Government that there's no medical intervention available to meet gambling addiction?

Vaughan Gething AC: We will, of course, look at all the evidence available about how to treat gambling addiction in the first place, but I want to come back to your first point about the prevalence of gambling and the ease with which gambling can take place. It's no longer, if you like, an unusual or regulated activity that peoplehave to make an effort to physicallygo to. There's a challenge about online gambling in particular, and there's been a recent and well-run public debate on fixed-odds betting terminals as well. Now, we're about to have new powers under the Wales Act 2017 where we could potentially do something with our powers, up to a minimum stake of £10. You'll notice that, in the report published today, the chief medical officer recommendsusing our powers to their fullest extent. We need to consider also the ongoingreview undertaken by the UK Government where they are talking about reducing the maximum stake down to £2. The chief medical officer has put evidence in supporting that, so we need to think about how our powers may be affected if the UK Governmentdo take that step forward. I actuallythink that having that general approachacross the UK would be a good thing, but I'm interested in how we use our powers in restricting gambling in a way that is sensible and proportionate, recognisingthe harm that takes place, and at the same time about the treatmentswe offer for peoplewho are caught up in gamblingaddiction, because I do recognise the wide social harm it can and does cause.

Public Consultations

David Rees AC: 2. How does the Welsh Government ensure that health boards fully engage in public consultations on future health services? OAQ51671

Vaughan Gething AC: Health boards are responsible for working together and consulting the public regarding proposed changes to health services in Wales. The Welsh Government promotes good practice in engagement and consultation and supports health boards in working together with the public, their staff and others—including, of course, community health councils—to help ensure the best possible health outcomes and planning.

David Rees AC: Thank you for that answer, Cabinet Secretary. I'm sure, as you agree, it's very important that they do engage withthe public. AMBU has recently gone through three, or is going through three, public consultations—thoracic surgery prior to Christmas, and it's currently going throughthe major trauma network consultation and the boundary changes. I'm hearing that, in fact, the take-upby the public in some of these public meetings is very, very small. Surely it's importantthat health boards, when they recognisethat there are not many people attending, become proactive and actually go back out to the peopleto get the consultation. Otherwise, there's a report saying very little becausepeople haven't been attending. People may not attend becausethey don't know. Many of my constituents didn't know these consultations were going on. We need to get them out there. They have to get engaged with the people. They have to recognisethat, if they're not talking to them, if they're not attending—go back out and start again so thatconsultationbecomes meaningful and not lip service.

Vaughan Gething AC: I do recognise the points the Member raises. There's something important about the balance in what we have to do. We have to make sure that there is a genuine, proactive attempt to engage the public in consultations through a variety of different means. There's the personal conversation that takes place betweenpeople and staff, there's the written media, there are formal notices, there's having community meetings, there's all the online presence as well, and, of course, the communityhealth councils and their role in engaging with the public too.
I'm happy to join in with what Julie James said yesterday in business questions to encouragepeople who have not yet taken part in the major trauma consultationto do so before that closes next week. But we also have to accept we can't force the public to take part in consultations. It's often the way that, when there's a big and a broad subject, the publicaren't as likely to engage, but when there's a more specific and local proposal then, actually, you do tend to find that people engage. A good example is planninglaw, outside the field of health, deliberately. General conversations about planning tend not to have lots of people engaging, but aspecific planning proposal in a locality almost always does. But I'm happy to say that I think that we are genuinely looking to learn and to improve. And of course, on one of the proposals that you refer to—the consultation on thoracic surgery—there was confirmation on Monday that thoracic surgery will be centralised, in accordance with a recommendation from the Royal College of Surgeons, and it will be centralised in Morriston in Swansea.

Angela Burns AC: You're absolutely right, CabinetSecretary, we can't force people to take part in consultations. But picking up from the point that David Rees made, there are an enormous number of really good ways of engaging people at a grass-roots level and really taking the temperature of proposed changes. Organisations such as INVOLVE, who run consultations in England—they work very hard with local authorities and health boards, they run fun days, there's all sorts of new ways of actually getting to the hard to reach, rather than the very stale paper-based, or if you're lucky and get broadband, computer-based consultations that we have in a very, very small window, almost inevitably run over a Christmas or a summer holiday. I would like to ask you to have a good look at all the alternatives we can to reach them.
But, above all, the central point of my question is: do you think it is still appropriate, given the parliamentary review, that we actually have consultations now run by health boards, or should they be health and social care, given the fact that we're looking for such an integrated and seamless way of going forward? Because anything that health decide to do will have an enormous impact on local authorities, and on the provision of social care, and the provision of housing. And if we're trying to get towards this more holistic way of putting the person at the centre of their health needs, ongoing, then we really should look at it in the round. A lot of these consultations are all about the health side, and don't really bring in the other half of the very important provision that we should be providing.

Vaughan Gething AC: Well, there is something here about understanding the proposals referred to earlier by David Rees, who talked about thoracic surgery and the major trauma centre. Those really are specialist health serviceconsultations that need to take place. And my concern has always been that, if we avoid dealing with issues, then we'll allow ourselves to get into a position where the debate is more difficult, and the need to change is more urgent. So, I don't think it would be helpful to try and stop the health service from running consultations on the way in which services should change and be reformed. But of course, there are a wide range of those services that are properly about how health and social care work together. So, I expect health boards to have proper relationships and conversations with social care partners.
For example, on the consultation about Bridgend, which is ongoing at present, there is absolutely a conversation, not just with Bridgend local authority, but actually with partners in Swansea, Neath Port Talbot, and of course RCT and Merthyr as well, about the potential impact of those. So, there is a willingness and a recognition that health and social care need to work more closely together. Regional partnership boards and the public service boards are part of that, and when you get to having a consultation, I expect that to be the case as well. But I really don't think there is a case to say we should pause and stop what's being done now; we need to learn and improve, rather than putting a pause button on changing, reforming and improving our health service.

Simon Thomas AC: My engagement with my health board is going to be a lot more difficult after the events of the last 24 hours, I have to say, now I know information will be shared willy-nilly with the Government for the purpose of traducing engagement with the health board. So, just to confirm that I hope the Cabinet Secretary can confirm today what other information the Welsh Government has around Assembly Members' ownengagement with their health boards. What he has in front of him in his little file there would be useful to know.
But, from the point of view of the public, for them to get engaged in health board consultations, they have to believe that the consultation proposals are credible. Now, one of the proposals in the Hywel Dda health board area, which is likely to be put out in March, is one of a brand new hospital, somewhere in west Wales, to replace Glangwili and Withybush. For that to be a credible proposal, to be taken credibly in a consultation exercise, to be responded to credibly by the public, he has to tell this Chamber here today that the Welsh Government will provide the capital funding if a brand new hospital for west Wales is proposed. Will he do that, so that any consultation has some credibility around it?

Vaughan Gething AC: I think there are two broad points there. The first is on the points you made about traducing Assembly Members and their efforts to engage in local health boards. I think it's really important that every Assembly Member engages with their local health board around the future of health services. We've just had a parliamentary review that set out again that the current way that services are organised have served us well in the past but they're not fit for our future. So, we need to change them. And that's the national challenge that faces us.I think every Assembly Member should be properly engaged in that conversation. Again, the maturity that led to the parliamentary review needs to continue in that continuing debate. And I think that when it comes to a debate in this place, of course, there will be to and fro in the Chamber. It's not as if Ministers—[Interruption.]

Let's allow the Minister to be heard. Carry on, Cabinet Secretary.

Vaughan Gething AC: It's not as if Ministers are completely free from criticismand questioning of motives and integrity in this place. I think it is important that Members are open and honest with the public and this Chamber about what our views are and where we're going. And that's a standard for all of us to reach to as well.
On your point about where we are now, Simon Thomas, with the proposals that may come in the future, I've said in the past, and I'm being as open and honest as I can be yet again, that I can't set out the position about what proposals are or are not going to be discussed and put forward in the spring, as the health board have indicated. I'd encourage everyone to engage before then and afterwards, and if there are real proposals coming forward, then of coursewe will look sensibly at what those are. But you know that I can't say today that I will find money or resources for a future decision because that would not be an open and honest conversation, and you're asking me to do somethingbefore there is actually a proposal for me to respond to.
I'd remind people—[Interruption.] I'd remind people that not only is there a role for Ministers in this, but we're at the point of actually constructing theGrange University Hospital right now. The structure's going up. It's been a conversation that's taken a number of years following a proposal, and following a range of ways to look at the business case, to get capital ready to do so. I made the choice for the capital case to go ahead at the start of this Assembly term. So, there was a decision there, which I made, and that was after the case had been made and agreed, with buy-in from local public and clinicians about what to do to reconfigure the health system in that part of Wales.
I recognise the invitation to say something completely precipitous at this point, but I won't take up his kind offer to do so.

Questions Without Notice from Party Spokespeople

I call on the party spokespeople now. The Conservative spokesperson, Suzy Davies.

Suzy Davies AC: Diolch yn fawr, Llywydd. Minister, Social Care Wales has been leading the way in producing a new set of qualifications for care workers. And as well as simplifyingthe system, this is an opportunity to respond to some new issues that aren't reflected in existing qualifications. There's more public awareness, for example, about sepsis, and while care workers are likely to receive some training about recognising the signs of a stroke, they don't get that training for signs of sepsis at the moment, generally speaking. Bearing in mind that some people with comorbidities are more likely to develop sepsis than others, and that the signs can be confused with other conditions, would you ask Social Care Wales to consider including sepsis awareness training as part of the curriculum for the qualifications for care workers?

Huw Irranca-Davies AC: Suzy, thank you very much for raising this importantpoint. As well as raising this point, it would be worth mentioning the work of the cross-party group on sepsis, which has raised the importance of this, particularlyacross social care training as well, and I look forward to responding to that after discussion withmy officials.
We're all very aware now of the heightened awareness of sepsis and the importance of early diagnosis as well as early treatment. It is noticeable that even with the rise in awareness and the rise in the number of people presenting with sepsis, particularly over the last year as well, and, of course, an increase in the number of our older population who are presenting with this, the number of deaths through sepsis is declining, and it may be part of the fact of the increasing awareness, the increase in training right across the board that we are doing on this. We know that not every death through sepsis is preventable, but we know that some are. So, that early diagnosis and treatment is absolutelyvital.
Now, it's hard to draw firm conclusions at the moment from year-on-year figures. It seems to suggest that we are indeed doing somethingright in Wales with our training and withour approach. But I look forward to responding to the comments that have been made today, but also the work of the all-party group on sepsis, becausewe need to make sure it's working, not only acrossthe health sphere, but across social work as well, so that we can make sure that, at every point, there is an opportunity to do very early diagnosis and have the early treatment, and continue the good work that we're doing.

Suzy Davies AC: Thank you for that answer. That was my point, really, because I'm aware, of course, that hospital workers get this training, but social care workers don't necessarily. And that's why I'd like to see it mainstreamed in the curriculum for the qualifications.
Moving on to something else now, the Cabinet Secretary confirmed to me in a written answer—last year it was—that the money that Welsh Government put towards the social care workforce development programme is match funded by local authorities.However, you went on to say in the same response that for every £1 spend by Welsh Government, 44p is spent by local Government. I have to say that that doesn't quite sound like match funding to me. While I accept that councils are strapped for cash, I do remember that your predecessor made available additional moneys for councils conditional on evidence that it was being spend on social care improvement objectives. [Interruption.] I'm afraid, yes, you did. I have the questions and the answers to prove it.As the fund is now overseen by Social Care Wales, do they have the power to ask local authorities for greater contributions to the fund and do they have a remit letter from you about the outcomes that you might expect from it, not least whether Social Care Wales is to perhaps limit its own administration costs when administering that fund?

Huw Irranca-Davies AC: Thank you very much. Just to be clear, the figures that I have on the element of match funding are not the same. It certainly isn't 44 per cent. Of the £7.15 million funding to the regions to deliver social care training by Social Care Wales, I'm informed that 25 per cent of that—so, a quarter of that—is match funded by local authorities. But I'll go away and look at that figure of 44 per cent, because that certainly isn't anything that has been brought to my attention. So, yes, indeed, if the Member could send that to me I'll have a look at it. But, as she knows, within that, the priorities this year have included care and support at home, they've included recruitment and retention, career development and the implementation of theSocial Services and Well-being (Wales) Act 2014.
I'm grateful as well to the Member for raising those important issues of the work that we have to do on workforce training, because actually getting people to see that this is not only a valuable profession but a profession in which they are valued means we put the investment into the training, and it is a shared ownershipof this. It is a shared partnership in this through local authorities and Welsh Government. We are putting the money in. There is an expectation with the match funding that local authorities will also step up to the mark. But, of course, we'll keep this under review as well. But there is a significantportfolio of work now going on in this area, andI am constantly, wheneverI visit front-linesocial care workers, stressing to them the importance of the work, but alsothe necessity of us asAssembly Members, of us as Welsh Government, and also local authorities and everybody else, to really value and speak out about the value of this work, because we know it is truly the coalface in terms of our interface with some very vulnerable individuals.

Suzy Davies AC: Thank you for that answer. You'll be aware, of course, that the Public Accounts Committee was talking a little bit about this on Monday. They heard evidence about how the average working life of a social worker is less than eight years, while, by comparison, a nurse could be expected to work for 16 years and a doctor 25. While that means that new social workers are constantly needing to be trained, it also means that there is a real shortage of experience that can be passed on generationally, if you like, to trainees and newly-qualified social workers.
Bearing in mind what you've just said about the workforce fund, how do you expect to improve the numbers attracted to social work and stay in social work, more critically? Do you think that the new qualifications are material to that? Who determines the key performance indicators that Social Care Wales should be looking at in order to ensure progress on both those fronts?

Huw Irranca-Davies AC: There two things. One is that there is no one answer to this—there are a multiplicity of ways in which we take this work forward—and secondly to say it won't be overnight. But you are absolutely right in saying that some of the issues that you've raised already are important. We are working with social care workers themselves to try and devise the right package of incentives that shows actually that this is a valued career path, not simply a job. Those observations that were made in the PAC committee last week are very telling in that if you go into nursing or other areas you could be two or three times as long, seeing that as career progression.
We know also that some social workers are moving from social work into other career paths as well. You look particularly at things such as domiciliarycare workers within social care. So,doing things such as extending the register, as we are now doing—it's a tricky ask, I realise, for domiciliary care providers, but extending the register to domiciliary care workers on a voluntary basis from 2018, ahead of mandatory registration from 2020, is part of it. It's an essential part, because it's an essential part of the professionalisation of the workforce to ensure that we have social care workers that are appropriately qualified to deliver qualified care to the vulnerable in our society.
It is also working with Social Care Wales, with Qualifications Wales and other key stakeholders to develop clear career pathways—not a job that you go into and there's a dead end to it, or a job you go into and drop out of early, as those figures showed, but there's a proper career pathway here, that people can seethat they can develop over a long timewithin this career, such a valuable career that it is, withcontinuing education and learning that enable those social care workers to progress through their careers. And also, I have to say—I mentionedthe role that I have asa Minister in doing this, and I'm sure thatevery Assembly Member has as well, in speaking up forthe profession right across—that it'salso aboutworking with Social Care Wales to develop a marketing and a recruitment and retentioncampaign topublicise that positive image of what social care workers do.
One final point: we've also provided £19 million this year of recurrent funding for local authorities to work with service providers to help manage theimpact of implementing the national living wage. The national living wageitself ispart of thismultiplicity of ways in which we say thatthis is a valuable profession, with valuedpeople working in it,and we want to see morepeoplecoming into it and staying in it longer. We'll do that and we'll work with all the partners out thereto make sure thatthis is seen as aworthwhile career for the long term.

The Plaid Cymru spokesperson, Dai Lloyd.

Dai Lloyd AC: Thank you very much, Llywydd. May I ask the Minister what assessment the Welsh Government has made of the implications for Wales of the research from the British Medical Journal recently that links cuts in social care budgets to far higher rates of death in England?

Huw Irranca-Davies AC: The observation is well made and we know thecontinuing times we are in withstretchedbudget pressures, and there's no pointignoring this place and stand on my feet and say that we can do remarkable miracles—we'reworkingwithin the constraints that we have. What we do have in Wales, I have to say, is a very different approach to what we're doingwithin social care andwith health, not least in theapproach that's been taken with the apolitical, cross-partysupport that therehas been for the health and social care review, if you look at what we're doingwith the intermediate care fund, in that way of joined-up working. So, we're not looking for additional funding, although I'd love to have some, Dai—I really would. But it's also to do with how we usethe fundingthat wecurrentlyhave in a clever way.
I'vecome this morning from a visit in Cardiff, with my colleague Julie Morgan, looking at the independent living centre, which does exactly that. It uses the intermediate care funding, into which we've put £60 million over the last year, to look at the ways in which health and social care join up to provide that seamless care and allows people to stay in their homes or closer totheir homes for longer, for better, and tonot then wash up into later, more expensive forms of treatment andcare.
So, Dai, I recognise the point that's been made in that report, because it shows that we have to continue thinking how we make the most of the money that we have. He will know, of course, as well, that amongst the four proposals discussed and put out for consultation by the Finance Secretary and my colleague, Mark Drakeford, was a discussionon asocial care levy. I think it's pertinent that that is now out there for discussion because you and I and our families and our constituents will have to seriously consider, in the longer term, aswe look at the trends that we've identified in the indicators that the Welsh Government has brought forward as national indicators of the strain that the system will be under, how we rise to that. Part of it isthrough working more cleverly and part of it is byfinding the money. I would love to think that, in the next Treasury statement from the UK Government, they'd open the cheque book and say, 'Let's actually put something here', so that we canhave the consequentials, but we wait.

Dai Lloyd AC: Thank you very much for that response. Of course, the BMJ research does show that 22,000 additional deaths are caused annually in England because of cuts in social care budgets in England. That’s 22,000 people dying because of cuts to the budget. That’s what the policy of austerity is leading to. In addition to that, because the Government in England safeguarded, or ring-fenced, expenditure on health in England, the funding for social care took a massive hit as a result. That is why we see those 22,000 deaths: because of those cuts and because there isn’t enough money in the system.
Now, people always say it’s not always about the money, but, in the case of social care, money is the fundamental issue because there are people in hospitals when they shouldn’t be there. That is the outcome of the lack of social care. We will be talking about deaths in Ysbyty Glan Clwyd later on. Why are those people still in hospital? Because they can’t be discharged and go back to their own homes because of a lack of social services and a lack of funding.
As you’ve mentioned, in light of the parliamentary review into health and social care by Dr Ruth Husseyand the central importance of social care and the demand for transformation, are you, essentially, going to be calling for an increase in expenditure on social care, because that's what we need to do—not do more with funding that we don't have, but call for an increase in expenditure and an increase in the budget of the integrated care fund?

Huw Irranca-Davies AC: Thank you, Dai. A couple of things here: one is that, as you know, in stark contrast to what has happened over the border—I don't want to compare with what's happened over the border—what we have done is, in health and social care combined, which is the approach that we're taking, based on the Social Services and Well-being (Wales) Act 2014 and other legislation here, about that idea of integration. Similarly with the funding, there is more going into health and social care here in Wales than there is across the border. But we still know the strains on the system.
In addition to that, I have to say, these ideas of how we make that money go further—well, I've had repeated meetings, and very productive meetings, I have to say, over the last few months that I've been in post with, for example, the regional partnerships. The idea that we should do more joint commissioning—how do we actually make a bigger bang for our buck, so that we can say, 'Well, we've identified what the care accommodation needs are for the elderly'? We could apply this to other areas of thinking as well. How do we collectively say, 'We'll look at what we've got together'? How do we, on a regional footprint, provide for that and get bigger delivery—deliver more care homes and deliver more places and better outcomes for people?
One important thing with that is, I have to say, as tricky as it is, the issue of pooling budgets. This is tricky, because we're all elected Members—we have the mindset of an elected Member as well as sitting here thinking about policy in a highly strategic way. We know how difficult it is for people to say, 'Well, pooling budgets—doesn't that mean that we have to give up a little?' In some ways, yes, but if it delivers the right outcomes in terms of social care then we should be looking at that.
There are things in Wales that we can do more cleverly, more sharply and differently, and we should be doing that. But, ultimately, Dai, I agree with you—there is the bigger challenge going forward, both in health and social care, which is in the thrust of the health and social care review, which is looking at them together. That seamlessness of the pathway for somebody who is a constituent or a patient of yours—that they don't have to think about who's dealing with them or what authority is doing it, but that it feels like a wraparound. I'm convinced, as we look at some of the models with ICF funding, that that is absolutely the way that we should be going.

Dai Lloyd AC: Thank you, once again. My final question relates to the fact that the BMJ research also discovered that one of the other things that would help in preventing deaths, in addition to further funding, is the presence of registered nurses in social care settings. That's what the research has demonstrated. Of course, as we discussed the Social Care and Well-being (Wales) Bill in the last Assembly, your Government voted against amendments that would have enabled local authorities to employ registered nurses in social care settings. Bu, there are other ways of resolving that problem. So, in accordance with the evidence, what plans do you, as a Government, have to increase the number of nurses in social care settings as part of any plan to mitigate the fatal effects of austerity coming from Westminster?

Huw Irranca-Davies AC: Well, Dai, thank you for raising that point. As you know, through not only the consultation that precededthis, which was quite extensive, but the bringing forward of the regulations—a wide range of regulations—part of this is also what we do with the nursing requirement, particularly in accommodation care settings. The traditional approach has been to say, in effect, 'If you can provide a nurse within a care home, then it's all hunky-dory and you're done', when, actually, what we know is that, in some care settings, you will require more than that. In other care settings, you may require nursing through the night; in others, you'll need, actually, more during the daytime or vice versa. So, within the proposals that we've taken forward, we have given more flexibility, but it doesn't take away the requirement, Dai, to make sure that the needs of those within care home settings are provided for; it gives more flexibility to do it according to the needs of those individuals.
Now, that requires, I have to say, that those care homes, and the wider monitoring of those, need to make sure that they are assessing accurately the needs of their residents and then providing for them. If that means more than one nurse, it should be more than one nurse. If it means more than one at night time, it means that, because we know that it's got to be based on the individual needs there and the collective needs within that care setting.
So, it has moved to a more flexible approach, and I realise that that has caused some people to say, 'Well, does that mean we don't need one in every home?' Well, what it needs isthe right level of nursing for every single care home setting, and that's what we're committed to making sure is provided.

The UKIP spokesperson, Caroline Jones.

Caroline Jones AC: Diolch, Llywydd. Minister, last week a widespread failure in the NHS IT systems caused chaos for GP practices and hospitals across the country, with many GPs reporting that they were unable to access patient records. One GP described the situation as very frustrating and rather dangerous. Hospitals were unable to access test results and one patient was told he wouldhave to wait another month for the results of a biopsy due to the backlog caused by the systems failure. I hope you will agree with me that this is totally unacceptable. Cabinet Secretary, can you update us further on the reasons for this outage, and what lessons, if any, have been learnt?

Vaughan Gething AC: Yes, I recognise the inconvenience caused to staff and patients in the national health service following the incident last week. It's not thought that it was a cyber incident, on the positive, and, indeed, that it was a technical issue, although widespread. All affected systems were returned to normal by 8 o'clock on the same day. There's a challenge about having caught up with any potential delays and backlogs. Further work has been done today to provide a new firewall, and my understanding is that our systems are in a fit and proper place to move forward. But there is, of course, a broader question about investing in IT to deliver more in the here and now and in the future.

Caroline Jones AC: Thank you for that answer, Cabinet Secretary. NHS Wales Informatics Service have just announced that the new contract for the GP clinical systems and services will be awarded to Vision Health Ltd and Microtest Ltd. This has caused concern for many GP practices that use systems provided by EMIS Health Ltd. GP practices have been told that EMIS Health Ltd did not meet a number of the necessary tender evaluation criteria and that EMIS practices will need to choose an alternative system. Cabinet Secretary, can you expand upon the reasons that EMIS Health Ltd was not successful at the tender stage? Is it related to the news that NHS Digital have imposed significant penalties in the order of millions of pounds for failing to meet contractual requirements of the GP Systems of Choice contract in England?

Vaughan Gething AC: I should start by saying it was remiss of me not to thank NWIS staff who worked hard to resolve the technical issue last week and to make sure the disruption was not more widespread, and, indeed, as I say, it was resolved within the day.
On EMIS and the issue of systems to support GPs, I recognise it's a challenge because a significant number of GPs currently use one of those systems. I can't go into the full reasons for it because there's a period of legal challenge and so I can't make a full statement until that point in time. But Members, I'm sure, will be interested to know thatthe British Medical Association have issued a very brief statement, because the general practitioners committee of the BMA were engaged in the discussions about the future tendering, and they themselves have said that they recognise that, whilst it's difficult, they think the right choice has been made because minimum standards have to be met within the contract process. But I think it will be towards the end of next week or the start of the week thereafter when the legal challenge process will be over and, if there is no challenge, a fuller statement can be made.

Caroline Jones AC: Thank you, Cabinet Secretary. Whatever the reasons for the decision against EMIS Health Ltd, this affects many GP practices across Wales who have been using the EMIS system for many years. The Royal College of General Practitioners are concerned that this will have a detrimental impact on both GPs and patients due to the scale of the changes needed to move to a new system. There are fears that this could risk pushing older GPs to an earlier retirement. Cabinet Secretary, how do you plan to address the concerns that an already overstretched profession does not have the time or resources to move to a new IT system, and are you confident that the new systems provided by Vision and Microtest are robust enough to prevent failures like we saw last Wednesday?

Vaughan Gething AC: I think that the issues are different, with respect. The issues about the data centres I don't think are the same as the software and support that we're talking about to support GPs to work in their practices. And I go back to the statement made by David Bailey, the chair of the BMA Welsh council, who is also a GP himself, and his practice actually uses EMIS systems. He's recognised that it will be a practical problem for GPs in migrating to a new system, and that's why conversations have already taken place about the required training and support to help migrate practices into a new softwarethat meets our requirements for the system that we have to run here in Wales. And that's the point: we have to have a system that supports the aims and objectives of the way we want to run our system here, not our system being driven by the demands of an external software supplier.
I do recognise the practical challenges about whether, if GPs don't feel supported in doing this, some may make a choice to leave the profession earlier than we would of course want them to. That's why the continuing nature of our conversation with both the British Medical Association and the Royal College of General Practitioners really does matter. I want them to be assured that there is a real will and commitment from the Government and the wider health service to support them in doing so and to continue to provide excellent, high-quality care to every community in Wales.

Community Health Councils

Bethan Sayed AC: 3. Will the Cabinet Secretary outline progress on plans to change community health councils in Wales? OAQ51680

Vaughan Gething AC: We are giving detailed consideration to the many consultation responses to the proposals in our recent White Paper, in which changes to community health councils are one. Officials and I remain in discussion with representatives of the CHCboard regarding their constructive response to the White Paper. A consultation summary report will be issued in due course.

Bethan Sayed AC: Well, of course, Cabinet Secretary, I think that if we're going to have the grown-up debate that you want us to have on the future of the health service, we need to have a community health council sector that is able to respond effectively to that call as well as the politicians. I believe that community health councils are crucial, but I have some reservations from my own patch about how they've reacted to previous problems with regard to Princess of Wales Hospital and, more recently, with regard to the Kris Wade scandal. But that doesn't take away from my fundamental belief that I do not believe that a Wales-wide body will solve this problem. For me, it's about trying to give community health councils guidance, to give them standards, to standardise practices across community health councils and make sure that they are visible. In fact, the former community health council chair of Abertawe Bro Morgannwg University Local Health Board actually told me that it was the best-kept secret in Wales, and I think that's quite a shocking statement to come from a chair of a community health council. So, what are you doing in relation to this concept of a Wales-wide community health council? Are you still going to go ahead with it, despite those reservations?

Vaughan Gething AC: As I've said, we are gathering together the consultation responses, and we do continue to have a very constructive dialogue about how to take forward proposals, but I think all of us want to see a new citizen-voiced body that is able to properly cover the fields of health and social care, and you can't do that without replacing CHCs, because their current remit set out in primary legislation just doesn't stretch into the social care field. So, that's really important for us to achieve. Actually, there are some people who take your view that a national body shouldn't be the answer, but actually we already have a national body with the CHC board. It's about making it work and ensuring that we can deal with some of the concerns that people do have about a national body being set up in one remote location—whether it's Cardiff, Aberystwyth or Bangor—and that wouldn'tthen have the local status and the local organisation to have a presence within local communities.So, those concerns are being taken seriously, and as we both have the consultation responses and we've moved forward to then having what I hope will be proposals for a Bill, these are obviously matters that will want to set out in detail, how we propose to deal with those, but those conversations are not complete.

Nick Ramsay AC: Cabinet Secretary, I think that Bethan Jenkins has made some very good points, and they're points that have been made to many others as Assembly Members from across Wales. I met with my own local community health council last year, and they were concerned about some of the possible proposals to come forward from the Welsh Government in this area. They're not averse to change and they understand that the system, the sector, does have to change. In terms of the structure—whether it's a national body or a local body—that's ultimately for you to decide, but will you, however, ensure that you do listen to patients, ensure that there is a patients' voice as part of this system, whatever structure that may be? Let's not lose that vital aspect of the current CHC system, which sees volunteers going into hospitals, seeing on the ground with spot checks problems that are happening, problems that patients are facing. These are what we really need to hear fed back to the system; we don't just want a bureaucracy that doesn't have the patient's voice at the centre of it.

Vaughan Gething AC: This has been part of the very sensible and constructive conversation that we've had: how do we make sure that there is a genuine patient voice, a citizen voice, across health and social care? How is that organised in a practical way to take on board the parts that have been successful within our system and to deal with some of the challenges that no-one suggests have worked well? Part of the focus has been on the ability for a community health council or its successor to be able to actually undertake visits, and there's a challenge there about doing that in a way so it doesn't disrupt patient care but actually makes sure that there is access and the ability to undertake some unannounced visits as well, but not confusing the mission with a citizen voice bodyand the work of the formal inspectorates—Care Inspectorate Wales and also Healthcare Inspectorate Wales. And, actually, there is a tension there to be resolved, because at thetime the CHCs were created we didn't havethose other formalised inspectorate organisations. So, it's about making sure that there's clarity in the mission thatdoesn't stop those important visits to understand and to hear directly from citizens as they're receiving and taking part in care themselves. So, I recognise the issues and of course they'll be part of our consideration going forward.

Mick Antoniw AC: Cabinet Secretary, the White Paper suggested thatthere was a duplication of inspection roles with community health councils and Healthcare Inspectorate Wales, but the community health council inspections are, in many ways, quite different. They are unannounced and can occur at any time, they include patients and relatives and they also involve follow-up visits. So, it seems to me that there's an important element there that is vital that we don't actually lose.
There was one further function, which, again, was part of thesubmission that I put in after various consultations, and that is the role of community health councils in the planning process. I've raised this with GP practices, but the fact is thatwhere we have, for example, large housing developments, there is a lack of engagement, properly, with thehealth boards and with thelocal GP practices on the impact of such developments, and, also, there's the important role that community health councils could, perhaps, play within that context. It's essential that that role really is beefed up and it is an important one that we really need to develop that doesn't exist at the moment, but could be one of the very important functions that community health councils do play in the future.

Vaughan Gething AC: Dealing with your second point first about the broader planning process, of course it's a conversation across theGovernment about our planning system, and the way in which, when new residential properties in particular are created, there's an impact on wider services, such as thehealth service, which is an obvious one, and with schools being another one and transport being obvious parts that are affected. So, there is a need to look at how different parts of not just the health service, but those actors around it, are able to take part in the process and have a proper say and a conversation with the reality of the impact of future development. So, I recognise the broad point that you make.
On the point about the difference between a CHC visit and a formal inspectorate visit, the CHCs themselves recognise that there is potential for duplication, which is unhelpful. They actually try to have a protocol between themselves and HIW in particular to try and demarcatethe different roles that they have and how they should complement each other. Part of what we'll want to do in taking forward the White Paper is to make that clear so that it makes sense to the citizen, but also to the inspectorate and the people who are looking to undertake thatwork, because I recognise thatthere is real value in it.

Out-of-hours GP Services

Caroline Jones AC: 4. Will the Cabinet Secretary make a statement on out-of-hours GP services in South Wales West? OAQ51664

Vaughan Gething AC: Thank you. I expect health boards in South WalesWest to provide safe and effective primary out-of-hours services to respond to urgent healthcare needs when GP surgeries are closed. In South Wales West, that point of contact and access is now the 111 service.

Caroline Jones AC: Cabinet Secretary, the BMA recently conducted a survey of GPs offering out-of-hours services. Nearly half of all respondents do not provide any out-of-hours services. Those GPs were asked to identify the main barriers to out-of-hours provision: 64.3 per cent cited exhaustion from daily pressures as the main barrier. In my region, over the last couple of years, four practices have closed and 13 are on the local health board's at-risk list, and a further 12 have indicated thattheir future is uncertain. If more practices close, we won't be able to provide adequate in-hours services, let alone out-of-hours. Cabinet Secretary, what plans do you have to address workload pressures to enable a greater number of GPs to provide out-of-hours care?

Vaughan Gething AC: I think the Member comes to thepoint about the future of local healthcare. It goes back to some of thequestions that we touched on earlier on. Trying to run the current system thatwe have is a recipe for failure for the future and there was a very clearmessage in the review for all of us to take on board.
In this Chamber, we've had a number of conversationsabout the future of local healthcare and what it will look like. We talked about the fact thatGPs were, more and more, working in an integrated team. Many GPs are already doing that and there are other parts of our GP workforce that are still on thatjourney. And as we learn more about clusters and the debate that we recently had in this Chamber, we'll learn more about what works, and then part of the challenge the parliamentary review has set for us and the Government in particular is: how do we enable that to happen more consistently across the country? How do we spread learning and share learning and have less tolerance of local practice thatis not good practice? How do we make the job easier and better for GPs? That's part of whatwe need to do and access and triage are part of that necessary conversation as well. We'll actually then have a better job for GPs already in the system. But, of course, with 'Train. Work. Live.' we do have some success in getting more trainees to come into our system as well. So, we need to both safeguard those people already in the system and make sure that their job is enjoyable, that it's done in a way that is forward-looking and not stuck in a past that existed and served us well in the last 20 or 30 years, and at the same time make sure that general practice is an attractive career that keeps people in Wales.Of course, there's a broad conversation now to be had with the wider public on the way that GPs themselves are trained.

David Rees AC: Cabinet Secretary, I welcome the 111 approach in south-west Wales because, clearly, that is one way of choosing well, making sure we get the right choices and avoiding going to a GP out-of-hours unnecessarily. But we also need the GP out-of-hours with certain things that are necessary. As such, I'm aware that there are challenges facing these services because GPs aren't coming forward to take on those practices. In my own area, Neath Port Talbot, there's a very serious concern about some of the sessions being covered by GPs and the lack of them coming forward. What is the Welsh Government going to do to ensure that we don't lose that service in the locality? Because the Afan valley people, having to go to a GP— if they end up having to go to Morriston, it's a very long way and they're unlikely to go there by themselves: they end up calling an ambulance. It's not the right way we should be doing it. We should be making sure that the local GP out-of-hours is there for them, in that locality, if needed.

Vaughan Gething AC: Yes, and I think that's the point: if needed, and who is the right healthcare professional. Part of the success of 111 has been the fact that most of the system that was introduced in England was actually a group of non-clinical call handlers with an algorithm—ascript to go through. Often that was rather more cautious and ended up directing people into accident and emergency departments when it wasn't necessarily the right thing for them to do. In Wales, we've spent more time on developing a proper clinical desk. So, you normally have a GP, you normally have a nurse and a pharmacist, and now we're introducing a therapist, and there is often a physiotherapist. So, you get that broader team in actually answering the call at the first port of call as well, and it's been successful. There's been evidence and evaluations that have been undertaken by Sheffield university medical research centre, which showsgood practice in the roll-out of 111 here in Wales and a good reason to roll it out. That has to go alongside the extra robustness of having the right healthcare professionals, including, of course, GPs, within the service. I do recognise the fragility we have in some parts of our system here in Wales; that's why getting 111 right will really make a difference so that those GPs who do take part will want to continue to staff our out-of-hours service.

'Continuing NHS Healthcare: The National Framework for Implementation in Wales'

Hefin David AC: 5. Will the Cabinet Secretary make a statement on 'Continuing NHS Healthcare: The National Framework for Implementation in Wales', published in June 2014? OAQ51677

Vaughan Gething AC: Thank you for bringing your copy again. The national framework sets out a process for the NHS, working together with local authority partners, to assess health needs, decide on eligibility for continuing NHShealthcare and commission and provide appropriate care for adults in a consistent manner across Wales. It is currently subject to review.

Hefin David AC: That's the news I was looking for: the fact that this document is subject to review, which, of course, is for adults, and this document is also subject to review, which is the document for children's continuing care. These two documents together represent the journey that a child may go through from childhood to adulthood, and I get the distinct impression that social services currently don't buy into this document, and this document is the responsibility of health services. What concerns me is that I've heard that the review is a tidying-up exercise. Well, the children's document was 2012 and the adults' document was 2014. I think we need something more fundamental than a tidying-up exercise. I think we need a fundamental review, which will engage with social services, health boards and the children's commissioner to ensure that the weaknesses that are recognised in these documents are engaged with, and reduces the need in future for health boards and social services to call for legal guidance and provide much more certainty than they currently do.

Vaughan Gething AC: I think that it's a fair point. Following on from the question you asked the First Minister—and I recognise the point you made about social services buy-in—we'll need buy-in from health and social care into both parts, in particular not just around transition, but actually just getting the system right. So, in reviewing that, we do expect partners and other stakeholders to be involved, and I'm also pleased to say that my understanding is that the children's commissioner's office will be engaged in part of that review as well. So, we have the right people together at the right time to look at both documents together, and hopefully then to improve the system that we have. The reality is that there will still be difficult choices to make within continuinghealthcare. That's why the journey of integration between health and social care is really important, to try and make it as easy as possible for citizens to navigate through the system and not to have to understand a difficult and complex system themselves. So, all of these things together really should make a difference for the individual.

Paul Davies AC: Cabinet Secretary, as I'm sure you're aware, the auditor generalpublished a follow-up report on this specific issue in 2015 that indicated that some health boards have not demonstrated that they are able to deal in a timely way with the claims they are responsible for, and that some claimants are being dealt with unreasonably. Are you now in a position to provide an update on this particular matter, and can you confirm that all health boards in Wales are now dealing with claimants reasonably and responsibly, so that people can have confidence in the entire system?

Vaughan Gething AC: I do understand the concern that's being raised, and I'm sure that, as with other Members, I've had constituents approach me in my local Member capacity with some concerns about the process in the past. It is my understanding that there's been a significant improvement in dealing with that backlog of claims, to try and resolve them, and I have received assurance that health boards have improved the position. I would not want to try and set an absolutist position because there is always room for error in any human service. If Members are aware of individual challenges that exist, I would want them to bring them forward to their health boards. If they don't get a response there, they can always write to me. I'm not aware that there are any system-wide pressures, but I am of course always happy to learn from a further review that I'm sure will take place at some point in the future.

Neuroendocrine Tumours

Vikki Howells AC: 6. Will the Cabinet Secretary provide an update on how the Welsh Government is supporting people affected by neuroendocrine tumours in Wales? OAQ51647

Vaughan Gething AC: Yes. The Welsh Government is committed to improving neuroendocrine tumour services. The Welsh Health Specialised Services Committee commissions care for patients in north Wales, and is working with health boards to implement the recommendations of its service review for south Wales to look at how patients can be better supported.

Vikki Howells AC: Cabinet Secretary, will you join with me in congratulating my constituent, Janet Lewis, whose leadership in devising solutions to improve healthcare provision and equality for patients with neuroendocrine tumours led to her becoming the well-deserved winner of the endocrine nurse award for 2018? More generally, how is the Welsh Government working with Welsh patients and healthcare professionals to make them aware of the specialist services offered at the University Hospital of Wales site, so that they may benefit from the expertise of Janet and her colleagues?

Vaughan Gething AC: Well, let me start by recognising the achievement of the Member's constituent, Janet Lewis. I'm always pleased to hear of yet another healthcare professional in Wales being recognised by her profession for excellence and achievement. It does say something about the fact that we are improving a range of our services here in Wales, which is not always recognised in other parts of the United Kingdom, but there is real excellence within the service here, and this is one such example. Because it did come from a review that recognised that we weren't doing well enough. Following that review, which actually brought in patient representatives as well, they had some confidence that we'd looked at the right things, and that service is being rolled out. There's been another peer review to check on progress, and that set out a number of areas for further improvement from Cardiff and Vale themselves. Again, there's something about learning, and actually that they are now being proactive and, through the commissioning arrangements of the Welsh Health Specialised Services Committee, making sure that people are generally aware of the excellence that is now being developed within Cardiff and Vale, to be made available for people right across south Wales as well.

Angela Burns AC: Will the Cabinet Secretary outline what considerations are given to screening patients who are at a higher risk of contracting neuroendocrine tumours, such as relatives of sufferers or patients who suffer from rare family syndromes such as multiple endocrine neoplasia or Von Hippel-Lindau syndrome, because in all of those there's been a very clear genetic link established? I just wonder if they need to have automatic screening rather than waiting until they have actually got the disease.

Vaughan Gething AC: This comes back to one of our challenges. I would always like it to be the case that we could have a screening programme that was effective in terms of the value that we get from it, in terms of money and also the outcomes and helping us to identify people early. But part of our difficulty in this area is that there isn't a full understanding of what causes neuroendocrine tumours. As with every area, where we look to have a screening programme we look for genuine scientific evidence. We all like to be evidence-led, not dogma-led, on this issue about what we should do. So, if there is an evidence-led process and there is an appropriate screening programme for individuals who are at greater risk, then we will of course look at that seriously, and as with other things, look to implement it here in Wales.

Preventing Ill Health

John Griffiths AC: 7. What Welsh Government support is available for initiatives to prevent ill-health in Wales? OAQ51653

Vaughan Gething AC: The Welsh Government directly funds a number of national organisations, services, programmes and settings-based approaches aiming to prevent ill health. These include smoking cessation services, immunisation programmes and healthy schools and workplace programmes.

John Griffiths AC: Cabinet Secretary, in accordance with the Well-being of Future Generations (Wales) Act 2015, I think it's widely accepted, and I think Welsh Government would certainly support a move to a more preventative approach in dealing with ill health in Wales, and being more proactive. Where there are examples, as I believe there is a particularly good one in Newport of the local health boardcoming together with Newport Live, as the leisure services organisation, Natural Resources Wales, Newport City Council and a range of sports bodies, to try and achieve a more active local population to be preventative in terms of ill health—. Where there is a good local coming together of that nature, what support might Welsh Government offer to facilitate and encourage? I know that previouslythere was mention, for example, of well-being bonds as being one possible vehicle to support pilots in local areas in Wales, and I just wonder if that's still a possibility or if there's some other means by which Welsh Governmentmight offer that support.

Vaughan Gething AC: There are a couple of specific things to talk about, apart from the generality, or the £600,000 of funding that goes through Sport Wales to Newport for core funding services and the Community Chest funding services. You'll be aware that the well-being bond is a manifesto of commitment and it's in 'Prosperity for All', the national strategy. I'll be making an announcement on that in the coming months.
There's a range of different areas where we do take action and support activity. There's a more general preventative approach in healthcare services, but working with other partners, and the continuing partnership with Public Health Wales, healthboards and Sport Wales is an important one. I expect to meet with my ministerial colleague, who's not in the Chamber at the present, to have that conversation on the joint work that Public Health Wales and Sport Wales have been doing. I'm also interested in what the professional sports are doing to actually promote, not just sport, but broader physical activity, and that's why, as an example of not just physical activity, you hear about Ken Skates and active travel.
We support a range of activities. We've supported walking groups in December—further funding to have local walking groups through Let's Walk Cymru, with funding to take them through to April 2019. We support a wide range of activities. We do recognise that not everyone is interested in the world of sport. How do we make them interested in more general physical activity, and how do we make it easier for people to undertake that activity and see the benefits for themselves, and not simply for the Government?

Mohammad Asghar (Oscar) AC: Last November, Cabinet Secretary, the British Medical Association published a new position paper on the use of e-cigarettes, and I quote whatthey stated:
'There are clear potential benefits to their use in reducing the substantial harms associated with smoking, and a growing consensus that they are significantly less harmful than tobacco use. With appropriate regulation, e-cigarettes have the potential to make an important contribution towards the BMA’s ambition to achieve a tobacco-free society, leading to substantially reduced mortality from tobacco-related disease.'
In view of this, Cabinet Secretary, what action are you going to take to promote the use of e-cigarettes in Wales as an alternative to tobacco smoking? Thank you.

Vaughan Gething AC: I think we should think again about some of the language that the Member has used: you said that e-cigarettes are significantly less harmful than tobacco. That does not mean that they're not, themselves, harmful; it's about the balance in harm. And it's also about a recognition that we don't always understand what goes into an e-cigarette. We had this debate in this term with the public health Bill, and in the last term as well there was a change of position about our ability to regulate this area. There's something about being able to regulate the products, because, actually, if you don't know what's in an e-cigarette, that's rather difficult, and I think there's something there for us to continue to consider. The Government has no intention of promoting e-cigarettes. There are choices for people to make themselves, as citizens of the country. I think that we have to, as I said earlier, continue to be led by evidence on what we could and should do, what we could and should promote.

Thank you to the Cabinet Secretary.

3. Topical Questions

Item 3 is the topical questions, and the first question is from Darren Millar.

Mortality figures in Welsh emergency departments

Darren Millar AC: 1. Will the Cabinet Secretary make a statement on mortality figures in Welsh emergency departments? 120

Vaughan Gething AC: You raised this yesterday with the First Minister, of course, and he made clear that the figures take no account of age, deprivation or ill health. I'll refer you back to his comments:
'Now, the particular measure reported involved small numbers and it's consequently not age adjusted. Age is likely to be the main reason why this figure seems high, not least reflecting that Conwy has the highest percentage of over 75s in the whole of Wales.
'More recent figures from the health board show some reduction in the peak reported. The overall in-hospital mortality rates for Ysbyty Glan Clwyd are in line with theWelsh average.'

Darren Millar AC: As you will know, Conwy has always had an older population than other parts of Wales, and, indeed, historically, its mortality figures at Glan Clwyd's emergency department have been below the Welsh average. So, age is certainly no excuse for the extraordinary increase that we've seen in death rates in that emergency department in recent years. They have more than doubled since 2012, and I'm afraid that your complacent response will not wash well with patients in north Wales who want to know why they are almost twice as likely to die in that hospital as they are in other hospitals across the country, and the situation there appears to be much worse than in Wrexham and in Bangor.
This is a cause of significant concern to my constituents, many of whom have contacted me following the report, and it was clinicians who contacted me to say that they were concerned about these death rates. They say that the biggest problem in that hospital is a lack of access to hospital beds so that the individuals in that emergency department are not in an appropriate care setting to be able to look after their needs, and that is why people are dying unnecessarily in the emergency department.
Given that that is the view of the clinicians and the nurses who have contacted me to express their concerns, will you accept that the lame excuse that you've given to date is unsatisfactory? Will you undertake an immediate investigation so that we can establish whether the situation is being caused by bed shortages? And what assurances will you give to make the results of that investigation public, so that the public can see what action you're taking, given that this health board is in special measures and being run directly by the Welsh Government?

Vaughan Gething AC: I have absolutely no intent of being bounced into an intemperate course of action by shouting and language that is deliberately fearful from the Member opposite. Sadly, he has form in this area.
Suggesting that there is complacency in the Government is simply not true. Just because I choose to remain calm and not engage in a shouting match, it's not because I do not care about the service and am not interested in improvement. It really is disappointing that an open system that we've put in place in health boards, to be open and transparent, is being traduced in this way, when you know very well that these figures are not adjusted to take account of other factors. You know that. You've seen the factual brief that comes out in stating that.

Darren Millar AC: Why is it double? Why is it more than double?

Vaughan Gething AC: And I really do think that the Member should take account also of the fact that within our system here in Wales, we are the only UK country—[Interruption.]

Darren Millar, you've asked your questions, now listen to the answers.

Vaughan Gething AC: We are the only UK country that has a full review of every death that takes place within hospital. There is already learning that deliberately takes place from deaths within hospital. I expect them to have an open and learning culture within our health service, to have a proper commitment to improving the quality and improving outcomes for people. If we are to work in a system where any attempt to have open and transparent publication of data is used in this way, to promote fear—and I do not accept Darren Millar's version of events as representing the view of the clinical community in Ysbyty Glan Clwyd or any other part of the country—then we'll run ourselves into a position where, actually, improvement will not take place at the pace that it could and should do. I take my responsibilities seriously, and I believe our clinicians do as well. And, yes, the results of those reviews are generally made available so we can see the learning that takes place from each of those reviews. And, in fact, other parts of the UK system now wish to learn from what we're doing in Wales to learn properly from every death that takes place in hospital.

Llyr Gruffydd AC: Well, I hope they're not learning from Glan Clwyd, Cabinet Secretary. But I would say, as the community health council said yesterday, yes, you would expect the figures to be higher, but these figures seem extortionately higher and disproportionately high in relation to the demographic difference that we do have in that particular part of Wales. So, I would ask you again to consider asking an independent person or an independent body to review those figures, so that we can have the confidence that you have—and I'm afraid I don't share your confidence—that there isn't a more systemic issue at play here that is causing what are clearly very concerning figures in Glan Clwyd.
Can I ask as well, given that you recognise that there are special demographic needs for that particular part of the country, are you confident that the board is being sufficiently resourced to address those? Because if they are, then there's another question about the way that the board is being managed under your watch in this regard as well.

Vaughan Gething AC: I'll quote from the publication itself:
'The following chart shows the number of deaths per 10,000 attendances for each major Emergency Department (A&E). It should be emphasised the figures reported are a crude mortality, and unlike deaths elsewhere in the hospital, no attempt is made to "standardise".As such there is no accommodation for factors such as age and severity of illness, factors known to impact on the risk of death.'
We can either have a conversation where we lay into the health board and try and suggest that there is somehow a political responsibility for an unacceptable death rate, or we can try to understand what has actually taken place. I would much rather understand what is taking place and to learn from that. That's why these figures are published. That's why there is a review into every death within the hospital. And, again, I will not be bounced into a suggestion that the clinical leadership at Glan Clwyd cannot be trusted. There are challenges right across our health service, and I will not collapse into blaming our hard-working staff for a range of areas in which we know that improvement actually is already there, and these figures are part of it.
And I would remind everyone in this Chamber that, when it comes to resourcing, the north Wales health board is the best-resourced health board in the country, per head. And actually our challenge is how we get greater value from every single £1 that we spend in the health service, including in north Wales. I do not see this as an issue of financial resourcing. If you're actually looking about the overall amount of money we have within health and social care then we're squarely into the field of austerity and its impact on public services.

Janet Finch-Saunders AC: Well, on behalf of my constituents in Aberconwy, I would like to thank Darren Millar for raising this issue once again in the Chamber. And I have to say I was deeply disappointed yesterday at the flippant remarks made by our First Minister in response to the question that Darren Millar posed of him yesterday, implying that age is likely to be the main reason why this figure seems high. We are talking about people who have died.
Now, when you look at the figures, compared to the population that Betsi board covers, I raised in October the board having the highest number of patient safety incidents classed as moderate, severe or death in Wales, including 41 accidental deaths. Now, in the figures coming forward, my own father is one of those statistics—accidental death resulting from an operation.
But let me take you back to A&E. In that 18 months period of my father's last remaining months of his life, I had many experiences of being caught in A&E with him, caught with other people on trolleys in corridors, ambulance men not being able to get back to their ambulances. The system, the through-flow of patients, isn't good. But I'll tell you what: you've got all your north Wales AMs here, on regular occasions, and our Cabinet Secretary, who raised the fact that there are issues—severe issues—of concern within the Betsi board.
Now, all I have—. You've been blamed and accused of supercilious arrogance. Yesterday, I accused you of disinterest. Prove me wrong, prove everybody wrong. Please, come with me—let me take you down the wards, where the people are on catheters, where you will see full jugs of water where no-one has drunk all day, where you will see catheter bags almost bursting. Come with us, Minister, Cabinet Secretary, and then, if you come with us—unannounced would be nice; I'm prepared to do it—I will show you scenes that you will find abhorrent.
Cabinet Secretary, you've accused us of political grandstanding. There is no political grandstanding worth the sorrow that one feels when you've lost somebody very close to you as a result of poor treatment in one of your hospitals. I don't blame the consultants. I don't blame the staff. I blame the process. It's not about money. It's about procedure. This hospital is under your direct control, and it ain't getting any better. Please, Cabinet Secretary, do something. Do something for all those constituents who come to me—

Okay, you do need to bring this to a close now.

Janet Finch-Saunders AC: Okay. I have two ombudsman reports that I had to report to the ombudsman: one where someone was terminally ill, and one now, where, as a result of these problems, I had a constituent—. Both were section 16 public interest reports. So, the evidence is there, if only but you would listen. Please, for the sake of every single patient needing to go into hospital, or the ones who are already there, please do something.

Vaughan Gething AC: Well, no-one could fail to recognise the grief that you clearly feel about the loss of your father. And I really am sorry for your loss. My job, in undertaking this role on behalf of the people of Wales, is to look at how we improve servicesacross the system, to understand how individual examples can be used to learn from, and that's the way in which we set out quality improvement within our system. We don't just empower, we expect people to be a part of improving the quality within our service. And, actually, in Ysbyty Glan Clwyd, they have a better than average mortality after surgery, both elective and non-elective surgery. So, it actually has a good overall record. Now, that does not mean that there will never be a mistake that is made, because we don't have perfection in our system, and it's not a standard that it's fair to hold anyone to in delivering the national health service. But we'll always look for further improvement, and, for all the passion and the grief that exists and I do recognise from the Member, I don't think that I should willingly accept the accusations that are made about my integrity and interest in the national health service. I'm in the business of public life because I want to help make our country better. Doing this job is a real privilege, and I absolutely have a significantinterest in thepast, thepresent and the future of the national health service. That's why I'm doing this job. That's why I'll continue to do this job, andto work alongside people in every part of our national health service to try and make sure that the future is a better one, and that we do the maximum we can do with the resources we have to deliver better healthcare in every community in Wales, and that is absolutely my honest and sincere commitment.

Thank you, Cabinet Secretary. The next question is from Simon Thomas.

The impact of leaving the EU on Wales

Simon Thomas AC: 2. What assessment has the Welsh Government made of the impact of leaving the EU on Wales in light of the analysis of three scenarios undertaken by the Department for Exiting the European Union, which was leaked on Monday? 123

Mark Drakeford AC: Thank you, Llywydd. We have published analyses on the general impact of leaving the EU, and also in areas such as regional investment and migration. Our trade paper will be published soon, based on independent analysis. We haven’t seen the document by the Department for Exiting the European Union that was leaked unofficially. We’re calling on that department to publish its analysis.

Simon Thomas AC: I thank the Cabinet Secretary. He will be aware, at least, from the press coverage of this analysis, that it looks at three scenarios: staying in the single market to all intents or purposes, leaving under World Trade Organization rules, and a situation where there is some sort of free trade deal of the type that the Prime Minister has been talking about.
Now, the three scenarios look over a period of 15 years, and, in each of those, there is a decline and a reduction in growth over that period of 15 years, varying from 2 per cent under the single market to 8 per cent under WTO. Now, the impact on Wales is going to be very detrimental indeed because we are far more exposed to certain aspects of this, particularly under WTO rules, such as the red meat sector, manufacturing, vehicles and so on, Airbus—just as an example of what can happen here. So, can I ask the Cabinet Secretary what the Government is going to do now in order to get hold of this analysis?
I understand that Westminster today has agreed in one way or another to share this paper with Members of Parliament in a closed room. I don’t think that that’s good enough at all. We, here, need to see this analysis too. We represent the interests of Wales as much if not more than MPs from Wales. And the Welsh Government needs to see the analysis; I want the Welsh Government to ask specifically for that. Of course, as the Scottish Government, and the Mayor of London himself, have commissioned independent reports and assessments of the economic impact of exiting the European Union, why won’t you do that and publish that too?
Now, it is about time that we realised the true cost of exiting the European Union. Yes, a decision to leave the political union has been made, but leaving the customs union and the single market will cost the Welsh economy very dearly indeed.

The Deputy Presiding Officer (Ann Jones) took the Chair.

Mark Drakeford AC: Well, I completely agree with the Member that the information that is in the hands of the UK Government should be publicly available, should be made publicly available and easily available, not, as Anna Soubry, Conservative MP, said in the House of Commons today, in the farcical way that the UK Government now appears to be willing to make this informationavailable to Members of the House of Commons in a locked room, whereas members of the public can read most of it on the internet any time they care to switch it on. She described it as a collective outbreak in the Government of a form of madness. And our callto the UK Government is absolutely that, where there is information that will help to allow people to make their own minds up about this very important issue, then there is an obligation on them—this is information that they have commissioned—to make that information available to others. As far as the Welsh Government is concerned, we routinely publish the information that we commission.In the joint paper that we published with Plaid Cymru a year ago, we included in that document an analysis by the chief economist and others of the state of information at that time. Within the next few days, we plan to publish the analysis carried out by Cardiff University of the impact of Brexit on major companies here in Wales, as we have already promised to different Assembly committees. As we get information, and as we publish documents, we always publish the independent analysis that we are using to draw the conclusions that we do, so that people who would wish to draw different conclusions have that information available to them to do so.

Jane Hutt AC: Cabinet Secretary, the External Affairs and Additional Legislation Committee held a very constructive and informative consultation event with a wide range of stakeholders here in Tŷ Hywel on Wales's future relationship with the EU. As a committee, we need to be fully aware of all future scenario planning and analysis to respond to stakeholders across the public, private and third sectors, and they were fully represented on Monday. So, I'd also call on the UK Government to publish in full the leaked document on the impact of Britain leaving the EU, which predicts that economic growth would be lower under a range of potential scenarios. So, I'd like to thank the Cabinet Secretary for clarifying, in response to Simon Thomas, its own approach in terms of scenario planning and the papers that you've already published and that you are—forthcoming—publishing the trade paper and other papers, and agree, and I'm sure the Cabinet Secretary would agree, that it's vital that the Welsh Government and this Assembly is fully informed in scrutinising the UK Government's approach to Brexit.On Monday, our committee Members will visit Toyota in north Wales and Aston Martin in my constituency. Don't you agree it would be helpful to have this analysis to assist us in our visits?

Mark Drakeford AC: Well, I certainly do agree. Of course it would be helpful to the committee to have that information. As I understand it, from reading newspaper reports of the work that the UK Government has commissioned, it does include some element of regional analysis. So, that would be immensely helpful to the committee in knowing where the different scenarios encompassed in that work see theimpact on Wales in particular of these three different routes to leaving the European Union. And it issensible of the UK Government to scenario plan in this way, but to scenario plan in secret is no help to the rest of us, andproviding the information in the way that Jane Hutt has suggested will be useful to committees here and to businesses and to ordinary citizens who want to understand what the potential impact of leaving the European Union might have in their own lives.

Mark Isherwood AC: You will know, as a Government Minister, that you have to have the freedom to ask your officials to do blue-sky planning, including all options, including some which you may be horrified by, so that the Government, in private, can decide what to prioritise, bring forward, propose and make public. An early draft of ongoing analysis in support of the UK Government's Brexit negotiations and preparations looked at different off-the-shelf arrangements currently existing as well as other external estimates. It did not set out or measure the details of desired outcomes, which the UK Government says is a new, deep and special partnership with the EU, or predict the conclusions of negotiations. It also contained many caveats and was hugely dependent on many assumptions where significantly more work was needed to make use of this analysis and draw out conclusions. In fact, this leaked analysis of just three scenarios was therefore incomplete and partial. As a Government Minister, therefore, how do you respond to the clear duty that Government Ministers have not to publish anything that could risk exposing negotiating positions until they have concluded what their negotiation positions are and have reached the stage where such information would not compromisethem when around the tablewith other parties?

Mark Drakeford AC: I have no objection whatsoever to UK Ministers commissioning analysis that looks at a range of scenarios, whichever of those scenarios they think might be useful. It is a sensible thingforthem to do. But I'm afraid that Mr Isherwood was reading out yesterday's circular from central office and not today's, because today, the UK Government has agreed to make all of thispublic. So, I'm afraid that all the things that he was worried about, which UK Government Ministers were worried about yesterday, have evaporated today intheHouse of Commons.
If Governments have anxieties that documents that they put into the public domain contain information that might be damaging to the public interest, then they are, of course, able to redact parts of the information that would have that impact. It is not an excuse for failing to makeavailable to the public information that allows a proper public debate of the mostimportant issue that we will face duringthe lifetime of this Assembly and beyond to beconducted onthe basis of the widest possible analysis and information.

Neil Hamilton AC: I agreewith the Cabinet Secretary that transparency is a good thing and that there's no reason why studies of this kind should not be published, because we can then draw our own conclusions, as he says. But would he agreewith me that anattempt to predict what the world's going to look like in 15 years' time,especially when those predictions come from economists, is likely to be about as much value as a witch doctor examining theentrails of a chicken? If such a study had beenconducted in 1990, nobodywouldhavespotted the existence ofGoogle, Amazon or Facebook.They are now three of the very largest companiesin theworld.
What we should do, perhaps, is look atthe forecasting record of the people behind this. Treasury forecasters, immediately after the referendum, forecast that, inthe following three months, theeconomy would contract by 1 per cent; in fact, it grew by 0.5 per cent. They also predicted that in the following four quarters, therewould be negative growth. In fact, we've hadgrowth inevery singlequarter since June 2016. They also predicted that, two years after thereferendum, GDP would fall by -3 per cent to -6 per cent. In fact, in 2016, the economy grew by 1.9 per cent, and in 2017, it grew by 1.8 per cent. It also predicted that unemployment would rise by between 500,000 and 800,000. In fact, unemployment is now at a record low sincetheearly 1970s. It also forecast thatborrowing would rise bynearly £40 billion; in fact, Government borrowing has fallen by 12 per cent and is now the lowest since 2007. So, I would advise the Cabinet Secretary not to spend too much time inexamining this particular piece of nonsense.

Mark Drakeford AC: Of course, the further away we go in time from today, the more imprecise attempts of this sort to predict the future become. However, if thisparticular chicken had been suggesting that the UK economywould be growing by 8 per cent as a result of leavingthe European Union, I'm sure the Memberwould have been a lot more kindly disposed towards it.

Thank you very much, Cabinet Secretary.

4. 90-second Statements

We now move to the 90-second statements. There's one this afternoon—Russell George.

Russell George AC: Mid Wales Opera is soon to be celebrating its thirtieth anniversary. The idea of Mid Wales Opera was born in Meifod, Montgomeryshire, in 1988, and beganwith opera scenesat the mid Wales centre for opera led bymusic teachers Barbara McGuire andKeith Darlington. Mid Wales Opera is still going very strong today and last year put on 27 performances—the company's most ever in a year—touring from Aberdaron to Ammanford and many points in between.
They bring fully staged professionalopera to the heart ofcommunitiesacross Wales and the borders, with main-stage performances each spring, and a small-stage community touring programme each autumn.Their main-stage tour of a Tchaikovsky opera has a cast of 15 and an orchestra of 12 from Bangor. They're currently rehearsing at the Hafren centre in Newtown for an opening performance on Saturday 24 February, before touring to Aberystwyth, Bangor, Newport, Mold, Llanelli, MilfordHaven and Hereford. I certainly think that it's great to see a professional touring opera made in Newtown and opening in the theatrethere before going off on the road.

Thank you very much.

5. Member Debate under Standing Order 11.21(iv): Leasehold residential contracts

Item 5 on our agenda this afternoon is theMember debate under Standing Order 11.21 on leasehold residential contracts. I call on Mick Antoniw to move the motion.

Motion NDM6626Mick Antoniw,David Melding,David Rees,Siân Gwenllian
Supported byMike Hedges,Julie Morgan, Jenny Rathbone,Russell George,Jane Hutt,Darren Millar,Simon Thomas,Jayne Bryant,Janet Finch-Saunders,Lynne Neagle,Joyce Watson,Vikki Howells
To propose that the National Assembly for Wales:
1. Recognises that leasehold residential contracts continue to represent a significant proportion of new build properties in Wales; and
a) that leasehold residential contracts are often offered on disadvantageous terms, resulting in detriment to the home-owner; and
b) that leasehold home-owners have little protection from unreasonable fees and unreasonable delays when buying, selling or improving their property.
2. Notes the UK Government's proposed ban on the sale of new-build leasehold properties in England.
3. Believes that the Welsh Government should take action to protect future home-owners by abolishing leasehold residential contracts in Wales.

Motion moved.

Mick Antoniw AC: Thank you, Dirprwy Lywydd. I'm grateful to the many Members who have supported this debatetoday. The level of cross-party engagement reflects the growing public and media spotlight on an issue that affects every one of the estimated 200,000 leasehold property owners in every part of Wales. Our debate here today, the action already taken in Scotland, and the proposals recently floated by the UK Government suggest to me that this is a serious debate and that a first principles review of leasehold contracts is well overdue—around 10 centuries overdue, in fact.
Leasehold is a relic from the eleventh century, a time when land meant power, and unfortunately it still does. For today's landowner, leasehold means maximising income and retaining control of the land they own. But for the leaseholderit means the exact opposite: uncontrollable costs and a lack of control over what they can do to the property they own. When the Scottish Government legislated to abolish feudal tenure, they got the tone exactly right. Like many Members, I've received representations from constituents where the root cause is the inherent unfairness, complexity and outdated nature of leasehold contracts. Complaints about spiralling ground rents, people feeling trapped in their own home, and property values that plummet year on year as the remaining lease reduces are commonplace.
Over the last few days, I ran a Facebook survey and I found that these headline issues are just the tip of an enormous and complex iceberg. One constituent told me that his lease was sold twice within a 12-month period, resulting in two separatedemands for ground rent. He had to go to court to resolve the matter. Another told me that, after the lease company went bust, the new companyincreased the groundrent overnight by 100 per cent. A third said that when she tried to purchase her freehold, her landlord valued her lease at three times the value of her home. Others told of house sales lost as a result of leasehold complications, the need to get permission to undertake the most basic repairs, and incurring charges for maintenance despite none beingundertaken.A number complained about the lack of information about leaseholdat the point of sale, with one left feeling that he'd been mis-sold. In recent years, there's been an avalancheof press reports across the spectrum of leasehold-related horror stories.
There have, of course, been a number of leaseholdreforms over the years, from restrictions on the rights of landlords to evict tenants in the 1920s, through to the 1960s and 1990s, which did bring new rights for tenants to extend leases. Leaseholdreform groups and organisations workingwith the sector, suchas the Conveyancing Association, have criticised the weakness of the Commonhold and Leasehold Reform Act 2002 for failing to offer leaseholdhome owners protection from unreasonable fees and delays in buying, selling or even improving their home. Legislation to date has not addressed the problem and it is remarkable how the issues that are so prevalent today existed 20, 40, 60 years ago. As one Welsh MP told Parliament:
'When leaseholders seek either to renew their lease, or to buy the freehold of their home, they are held to ransome.Leaseholders are completely defenceless before the ground landlord.'
'Because of the profitability of the leasehold system, finance corporations have bought out a great many ground landlords.'
That was a speech made to Parliament in 1961. Now, new problems are emerging. Some lenders are reported as refusing mortgages on leaseholdproperties, effectivelymaking the houses worthless. House values are eroded because of increasing ground rents, tribunalcosts and groundrents being sold as commodities on the financial markets.
One constituent of mine was charged £140 as an assessment fee when he sought to buy out his lease. He was completely astounded to be told that his freehold would cost him a staggering £13,000. He employed a solicitor, at a further cost of £420, who then negotiated the fee down to £8,000. So, it is sensible then that the UK Government have committedto work with the Law Commission to support legal reform.The complexity of leaseholdcontracts with elements of contract and property law intertwined also puts a home owner at an immediate disadvantage in respect of ground rent disputes. Speaking in the House of Commons in Novemberlast year, one MP put it like this:
'Present-day "onerous ground rents" are, more likely than not, the resultant of unconscionable conduct carried out by one sector of society who have superior information...at the expense of an unsuspecting...part of society.'
In April last year, the all-party parliamentary group on leasehold reform called for leasehold houses to be banned and for an end to onerous ground rents. Then, in a written statement in December 2017, the Secretary of State, Sajid Javid, announced a package of measures to crack down on unfair leaseholdpractices in England, including legislation banning new leaseholds. He said:
'It’s clear that far too many new houses are being built and sold as leaseholds, exploiting homebuyers with unfair agreements and spiralling ground rents. Enough is enough. These practices are unjust, unnecessary and need to stop.'
So, these too are encouraging words, but, so far, there is no sign of any UK Government legislation. A private Member's Bill due for its second reading in Westminster next month, however, will propose further regulatory reform.
In Wales, Welsh Labour's 2017 manifesto made our intentions clear and signalled that Labour is ready to introduce protection for existing leaseholders, saying:
'We will back those who own their homes, including...leaseholders...who are currently unprotected from rises in ground rents.... A Labour Government will give leaseholders security from rip-off ground rents and end the routine use of leasehold houses in new developments.'
So, I welcome the Welsh Government's 2012 'Homes for Wales' White Paper, which commits to working with the Leasehold Advisory Service to gather evidence on the scale, volume and nature of leasehold problems to inform further action. I'd be grateful if the Minister could outline what action is proposed as a result, and what further action might be considered as a result of this debate.
A ban on new-build leasehold houses is an obvious and necessary first step. In 2016, leasehold transactions accounted for 22 per cent of all transactions of new-build properties in Wales, and I do recognise the distinction between new-build homes and issues relating to apartments and flats, which is a far more complex issue, but one where there are still significant issues with regard to commonhold and leasehold.
Responding to a Westminster Hall debate in December 2017, the then Minister for housing, Alok Sharma MP, noted that
'whether Wales abolishes leasehold is a devolved matter'.
So, unlike in the eleventh century, our society values home ownership—it has been positively encouraged by Governments of all colours. We all understand that this is something that most people aspire to. So, the existence, re-emergence and growth of leasehold tenure is, in my view, a scourge on society. It is an embarrassment that this feudal landowner exploitation of home owners continues to exist, and it has to be brought to an end.
So, I call for three things: urgent temporary steps to restrict new leasehold builds within Wales, I call for the Welsh Government to introduce urgent legislation to permanently ban any further house building based on leasehold tenure, and I call for an inquiry into all types of existing leasehold tenures, with a view to legal reform to enable this complex and iniquitous system to be brought to a just end. Thank you.

Janet Finch-Saunders AC: I'm delighted to support this debate. Land Registry figures show that leaseholds made up 43 per cent of all new-build registrations in England and Wales in 2015, compared to just 22 per cent in 1996. We know that Wales has around 200,000 leasehold homes, with specific hotspots where there are significant levels of new builds being sold under leasehold contracts. Indeed, in 2016, in my own constituency of Aberconwy, we had the highest proportion of new-build leasehold house transactions as a proportion of all new-build house sales at 77 per cent, accounting for 48—that's 48—of the 62 new-build houses sold in 2016. Furthermore, 11.5 per cent—again, now the highest in Wales—of all houses sold in Aberconwy in 2016 were leasehold, alongside 27 per cent of all property transactions.So, it's actually the fourth highest.
Now, of course, leasehold ownership can sense when it's used for individual flats in larger developments. However, we have concern that far too many new houses are now being built and sold in this way, often without a clear explanation of the implications and costs for the buyer. And I have to tell you that it was quitea scandal when it emerged in Aberconwy. There was a newspaper story and people were approaching me. They did not know that they actually had a leasehold on their property, and some of them were offered to buy them at £3,000, but even then they were only buying the freehold on their property; the land wasn't included in the actual transaction. So, there are several facets to this.
This potential exploitation—and that's what it is—can see home buyers lumbered with unfair agreements and spiralling ground rents. I know if I was buying property, I would want to know that if I was buying it I owned the land that it stood on, I owned the property and that it was freehold—it was mine. To actually go into a transaction, go through the legal process, go through all the local searches and everything, and then to find out years later in some instances that you don't own the—[Interruption.] Yes.

David Rees AC: Thank you for taking the intervention. Do you therefore agree that it's incumbent upon the solicitorswho are acting, usually nominated by a developer, to actually ensure that the purchaser is fullyaware of the consequences of leasehold?

Janet Finch-Saunders AC: And you've just said it there now: the solicitors often are, if you like—. People are encouraged when buying a property to use a particular solicitor, so it sees our own local solicitors in the area out of the equation, if they are a large developer. And I think it is incumbent in any legal transaction, in conveyancing of any kind—I do believe that it should be that people do not go in where they are blindsided with not knowingthat they're not buying the actual freehold.
The potential exploitation sees home buyers lumbered with unfair agreements and spiralling ground rents. Direct Line for Business research in 2016 suggested that the average annual ground rent was £371 for new builds and £327 for older properties. And as I say, when it comes to buying the leasehold, these people were given a very short window of time in which to buy their freehold, and once that time went they were warned that they could escalate. What a worry that is to someone when they've bought what they believe to be their own home.
These practices are unjust, unnecessary and need to stop, and I was really thrilled when the Secretary of State for Housing, Communities and Local Government, Sajid Javid, previously announced new measures to put a stop to unfair practices, and at that time I did actually approach our late colleague, Carl Sargeant AM. And I know that he was very keen and he said he would come back to me. Sadly, he has been unable to. But he was definitely going to lookinto this and bring about some kind of solution.
Recent figures from the Leasehold Advisory Service show that 57 per cent of UK leaseholders generally regret purchasing a property in that way, and therefore these moves by the Conservative Government in Westminster to ban the sale of new-build leasehold properties, cut down on abuses of leasehold and ensure better protection for renters and home buyers are very welcome.So, all I would say is: let's go forward and let's do the same here in Wales. Our people when buying property, our Welsh householders, deserve every protection that is available across the UK. Thank you.

Thank you. Lynne Neagle.

Lynne Neagle AC: Thank you, Deputy Presiding Officer, for the opportunity to contribute to this debate. This is an important issue and I'm very pleased that we're getting the opportunity to discuss it today. Although the motion today talks about new-build properties, I wanted to raise the issue of leaseholders who have brought former council or social housing properties, and then faced very large bills to bring them up to standard. I have seen how much stress these bills can cause, especially as some of the bills in my constituency have been very large indeed—some as high as £26,000.
It is of course absolutely right following housing stock transfer that Bron Afon Community Housing, the main social landlord in my constituency, should have worked hard to bring the whole housing stock up to the Welsh housing quality standard. However, we also have to recognise that they inherited a housing stockthat had a very significant backlog of repairs due to the borrowing constraints placed on local authorities with council housing for many years.
I've raised concerns about leaseholders with successive housing Ministers going back over many years, and I'm particularly grateful to Lesley Griffiths for the interest and concern she's shown over this issue and her willingness to listen to my constituents about the impact such large bills were having on them. I well remember one constituent telling me and telling Lesley that it had reached a point where she dreaded getting another envelope from her social landlord for fear it was going to contain another large bill.
Now, of course there are challenges in tackling this issue of large bills for leaseholders, and there is a powerful argument that tenants should not be placed in a position where they have to subsidise works on the homes of those who have been able to buy their own home, but I do believe we have to do more to tackle this issue. In England, they passed something called Florrie's law, which places a cap on the level of charge that could be levied on local authority leaseholders, and this is something that I've raised with Ministers here.
Another suggestion I've made is that Ministers legislate to create a mandatory reserve fund that all leaseholders have to pay into in order to spread the cost of large repairs over time. So, like Mick Antoniw, I very much look forward to the Welsh Government coming forward with proposals to tackle the challenges facing leaseholders. I was very pleased a couple of years ago to be asked by Welsh Government to launch the new guides they'd produced in partnership with the Leasehold Advisory Service. These were guides that were designed to make sure that leaseholders facing major works were fully aware of their rights and entitlement. But as Mick Antoniw has said, there is also, I think, a very pressing need to make sure that people have information before going into a situation where they become a leaseholder, and that is very much missing at the moment. I'm yet to meet a constituent of mine faced with one of these bills who actually understood what they were signing up for when they bought the property. So, I would suggest that one very easy win for the Welsh Government going forward is to try and make sure that everybody who is about to sign up to a leasehold arrangement is very clear what that will mean for them in the future, and I hope that that is something—as well as the other measures that have been mentioned—that the Welsh Government can look at going forward. Thank you.

Thank you. Siân Gwenllian.

Siân Gwenllian AC: Thank you very much. Thank you for bringing this issue to the Assembly's attention. I'm very pleased to be able to participate in this debate. At the outset, I want to refer to one example—just one example but one that's quite complex and demonstrates the problems in this area, and one I'm very familiar with in my constituency. I want to mention a block of flats built for people over the age of 55, which were sold with leaseholds attached. Most of those who purchased those flats are now in their 80s and 90s. At the outset, a residents' association was established in the flats, but as the residents grow older nobody now takes responsibility for being on the committee, and this association that used to work for the benefit of the residents has now lapsed.
Some four years ago, the lease was sold to a company located a long way from my constituency. The company is based in the Channel Islands, and they now own the lease on the flats. This company has two levels of management and it's very difficult to communicate with them. The costs for the residents have increased swiftly. The outside of the flats were redecorated at a cost of £100,000. The work was of a poor standard and the roof is leaking in one of the flats. The company that holds the lease—that's the company in the Channel Islands and their agent—makes all of the decisions, and, of course, it's the residents who have to pay the bills. Any attempt to challenge the decisions has to be made by individuals because the residents' association came to an end. I don't need to tell you that their efforts aren't getting much success.
That's just one example of how leaseholds can create great anguish, and this trendformore and more developers to sell homes on leasehold is an increasing cause for concern. Some purchasers do get 999-year-long leaseholds—a very long time, one would think, which possibly may actually alleviate some of the anxiety at the beginning of the process—but discover later that buying the freehold is exceptionally expensive.
One trap for these buyers is the increase in ground rent, which is hidden in the small print of these long leasehold contracts. At the outset, it looks affordable and the contract says that the ground rent will double every 10 years. That can look innocuous, after all most people move house every seven to 10 years or so. But for the company buying the leasehold, the income is very valuable and doubling something every 10 years very soon makes it profitable, and before long it’s impossible for the residents to afford the ground rent, and therefore it’s virtually impossible to sell the home, with solicitors warning prospective buyers to stay away. So, young people, after years of paying rent, at last buy a house and then find themselves still, in reality, being tenants, because that’s what a leaseholder is ultimately, with all the disbenefits attached to that.
I’m going to use this debate to draw attention to just a few other problems that have emerged in terms of newer housing developments—I hope you’ll forgive me for doing so, and to stray a little off topic, but they are certainly related. Recently, the cross-party parliamentary group on excellence in the built environment—which is a long and complex title—published a report on the quality of housing that were new builds across the UK. This report discovered that 93 per cent of buyers mentioned problems to the construction companies, and of those, 35 per cent mentioned 11 or more problems. These are problems that the buyers have to pay to put right—a matter for our consideration in the same context, therefore.
Another problem is the number of housing estates the length and breadth of Wales that are unfinished. What happens very often is that a developer will take more than a decade from when the first house is sold to the time when the final house is sold and completed. In the meantime, residents face problems with rubbish collections, no social facilities available and so on, and as we will see in a debate that’s to take place next week, roads remaining unadopted. This is all before you start to think about other related issues, such as land banking, for example, where there is no intention at all to bring a project to conclusion, and also a lack of community infrastructure for these new developments.
So, there are a number of related problems there, and as far as I can see, there is a fundamental problem that we’re facing here: since the financial crash 10 years ago, fewer companies are involved in the market and they are larger companies and therefore there is less competition. This, ultimately, is damaging for house owners and gives unfair advantages to these large companies when it comes to the matter of funding new developments, getting planning permission, public procurement, and so on.
Therefore, I would encourage the Welsh Government to consider these issues too when you are seeking ways of dealing with the issue of leaseholds, because it is part of a wider range of problems emerging from less competition in the house-building sector. Thank you.

David Rees AC: I think we'll find the same message being sent across the Chamber this afternoon from Members representing constituents across Wales, because we all havesimilar problems. As we all know, leasehold is a form of residential tenure that, perhaps, comes back to the feudal ages, where land was seen to be the place and those who owned the land were the dominant ones, but it has actually been abolished in most places around the world and perhaps it's now time to end it here in Wales as well.
It started out as an anomalyin the north-west of England and it seemed to spread across the whole of the UK, selling houses as leaseholds. Now, let's—[Inaudible.]—leaseholds. Leaseholdsactually cover more than one area. We talk about houses sometimes, but don't forget flats, and we've got new houses and we've got existing houses.So, there are combinations of leasehold, which really add to the complexities that arise. I'll talkabout all three in a second.

David Rees AC: Now, to those who say a leasehold house is sold at a lower price than the freehold house,because that's what they would sell it as, that's been shown to be incorrect.It actually appears to be simply a way ofexploiting the home buyer—to actually get somebody to think that accepting a leasehold was a normal way of buying a home these days. It's not, and it wasn't.
On occasions, the details and the consequences of the contracts they went intowere never fully explained to them. And, again, that is crucial. It's very often because the developers would sell to the person—. I've been there, with my family and my children, to these houses and they say, 'We've got the solicitors. They know how we work. It's easy for them to do it.' Of course, then they encourage you to use their solicitors because they have the contacts, but they don't tell you what the nitty gritty is behind the detail, and that's the problem.
So, whilst they may present it as a cheaper option, it's not clear to the leaseholder what additional medium and long-term costs they will incur as a consequence.There are some leases that have terms that become increasingly onerous. I think Siân Gwenllian highlighted it, what is known as the Taylor Wimpey approach—the10-year doubling costs—and that is frightening, because sometimes there are 250-year leases and you're talking about 25 doublings. It'll be huge. It is something we need to address here in Wales.
So, what can the Welsh Government do for other things? For new builds there are two things: ban it; stop it. But also, the Help to Buy schemes: don't help to buy leasehold properties. Make sure that developers know that ifthey want to encourage people to buy the properties with Welsh Government funding, you are saying, 'On the basisonly if it's freehold, not leasehold.' Easy, quick win.So, that's one aspect.Obviously, on developments, don't let it happen; ban it outright for new properties.
But then that leaves the problem of the existing properties. What are we doing? Because Ihave tenants—. We've been very good today; we haven't named companies. I'll name them. Barrattin my constituency—very highly popular, doing a lot of leasehold properties and selling new properties as leasehold. Persimmon is another one. I've also got—. You'll remember. The Member for Llanelli will be interested in Trinity Estates. That's another one that runs amanagement company running flats in my area. It runs them in Llanelli as well. These are companies that are passing on theleasehold to third parties without the leaseholderknowing. They don't tell the leaseholder they're passing it on. It goes on once, twice, three times before somebody actually finds out now who owns the leasehold. Consequently, the charges are going up. The flats in Jersey Quayin my constituency, which are managed by the company—I've just forgotten the name of it.
In Trinity Estates, those owners actually have problems. They have to give a percentage of the selling price, if they try to sell the flat, to the management company. The management company can just take money out of their accounts for service charges, without giving them notification. They have increased their service charges by 33 per cent over the last 12 months. This is totally unacceptable to people. They can't sell their houses, as you said, which means people going into the properties can't move on. They're stuck. They can't progress. They can't even get jobs differently.They can't go anywhere. So, you are tying people into a situation that they can't get out of. We must support these families, these young people. Most of them are first-time buyers. We must help them so that they can become socially mobile, they can increase their lives, they can improve.
It's about time that the developers were held to account, it's about time the management companies were held to account, and it's about time the Government actually now did something that it promised to do. I understand that the Wales Act might muddy the waters a little bit because it's changing from, 'Property is reserved, housing isn't', butthis is housing. It's the ultimate housing issue—come with a little umbrella. So, I'm pretty sure you can do it.
So, Minister, I would like you to actually stop this process. Stop our constituents being trapped in a situation that they can't get out of and ensure that they're not being—I'll use the word—fleeced by management companies, so that they can actually not just simply afford their mortgages, but afford to live. Because we have situations where a £500 fee is taken out a month. Well, that's someone's mortgage gone. Just gone. They can't pay the mortgage because they've just had that money taken away for the service charge. It's got to stop. We've got to make sure people are protected. We've got to make sure that the residents, the tenants and the leaseholders are protected, not the management companies.

Gareth Bennett AC: Thanks to Mick Antoniw and the other sponsors of today's debate.The issue of leaseholds and freeholds is not a new one in Wales. I'm not going to attempt to go all the way back to the eleventh century, as Mick did, but we did have a well-publicised situation during the 1950s when a large number of miners' homes in the south Wales Valleys had leases that the occupiers weren't able to purchase. At that point, one company, Western Ground Rent, held some 10,000 leases, and there were attempts to reform that situation in Parliament at the time, led by someone who was later my local MP, George Thomas. Now, whatever reputation George Thomas has these days, he was involved in at least one useful campaign, which was the campaign to reform leaseholds in Wales during the 1950s and 1960s.
As we've heard in today's debate, though, there is evidence that leaseholds are still very much with us. As Mick Antoniw stated in his opening remarks, it's estimated that there are some 200,000 leasehold homes in Wales, and there is the disturbing aspect that a significant number of new-build developments are being offered to house buyers coming into the market as leasehold.
One point that Mick made was that he acknowledged that there was a difference between leasehold flats and leasehold houses, and some would argue that there may be a case for flats being leasehold, as they clearly have communal areas and will also offer communal services. But, then again, the leaseholders are paying service charges for these facilities, so why should they be impeded from each owning their own freehold?In the case of leasehold houses, though, it is even odder that house builders are trying to fob buyers off with leasehold arrangements. In these instances there are no communal areas, there are no service charges, generally, so there is even less justification for not offering the freehold.
In recent years there have been whole new developments that have gone up in which all the houses on offer were leasehold, and Dai Rees began to mention the names of some of the companies that have developed those arrangements. I noted today that, currently, on Darlows' website, there are no fewer than 185 leasehold properties on offer in Cardiff alone.
A significant problem is that many first-time buyers lack financial education of the sort that is needed when they enter the world of property purchasing. This is something of a failing of the education system, which is sometimes too academic in nature and offers not enough of practical relevance to school students. We do need to give young people some meaningful financial education to prepare them for entering the world of property, although that debate is perhaps for another day.
To return to the point at issue today, first-time buyers, desperate to get onto the housing ladder and knowing little, often buy a house, many of them not even understanding the difference between leasehold and freehold. Then, when they come to sell the house, they find that there is a significant difference between their market price and the market price of neighbouring houses in which the householders do own the freehold. For instance, one of my constituents, who lives in the Cynon valley, eventually sold her house for £110,000 because she was only a leaseholder, whereas other properties in the same street were going for £140,000. That is a significant loss, and that individual did not realise when she bought her property what a leasehold even was. So, this is one part of the problem we are dealing with.
Dai Rees made the point that, in these cases, we should try to do something to ensure that the legal advice that prospective house buyers are getting from solicitors does actually explain these differences between leasehold and freehold. But, of course, we've had a series of financial packages offered over the years in which false advice has been given, so I fear that, unless there is some kind of meaningful regulation, we can't really rely on regulation to ensure advice that is given from solicitors. So, I believe there are many problems associated with leaseholds; legislation could well be the only way forward. The legal competence issue, which Dai Rees also raised, is a possible problem, so I'm interested to hear what the Minister says about that today, and how she clarifies that. But UKIP supports the principles behind this motion, that house buyers should not be ripped off, and is happy therefore to support today's motion. Diolch yn fawr iawn.

Jane Hutt AC: I'm very glad to support and take part in this debate addressing an issue that has been raised by, and is affecting, my constituents in the Vale of Glamorgan. As part of the regeneration of Barry, 3,500 houses are being built on the waterfont, with substantial levels of support for home buyers, which I welcome, from the Welsh Government's Help to Buy scheme. In fact, Dai Rees has drawn attention to this: new home buyers are getting Help to Buy, but they are for leasehold properties. Of course, the redevelopment of Barry is transformational and has my backing, but concerns have been raised with me about the use of leasehold by the developers who are building these homes. I did raise these concerns with the Minister, who responded to me to say that two of the developers, Taylor Wimpey and Barratt, have confirmed that they no longer sell properties as leasehold unless absolutely necessary. The third developer, Persimmon, has also confirmed that they no longer offer leasehold properties unless absolutely necessary. So, I'll be monitoring this and questioning the 'absolutely necessary' point in terms of scale and type of properties.

David Rees AC: I was going to ask the question: did you get confirmation from them as to what 'absolutely necessary' means?

Jane Hutt AC: That is the point I'm following through and taking up. But it was important that I was able to raise that and get that response from the Minister. But I'm also aware that the Home Builders Federation has stated that they're working with their members to look at alternatives to leasehold, such as commonhold, using the right-to-manage legislation. I don't think that's been mentioned yet this afternoon. I also heard from the Minister that she'd like to see more right-to-manage companies being set up as they allow leaseholders to take control of the management of their buildings and free themselves from management companies that are not providing a professional and value-for-money service.
I'm also aware of not-for-profit management companies that are being set up. Indeed, we have some examples of those in my constituency, but, of course, they require considerable voluntary skill and voluntary management capacity.
I also understand, and I look forward to hearing from the Minister, that she's looking at the regulation of residential leasehold management companies as part of options for wider leasehold reform. But, as has been said, the Welsh Government is subsidising and supporting home buyers, particularly young home buyers, with Help to Buy, but there are disadvantages in the short and long-term leasehold arrangements being imposed on them. One of my constituents has said on behalf of her daughter in this position, 'There needs to be more information available about the hidden costs of leasehold to alert young buyers who are unaware of the pitfalls.'
Mick Antoniw spelt this out very clearly in bringing forth this debate, in his opening speech on the inherent unfairness and complexity of the leasehold system. He asked the Minister for clarification over when she'll be making an announcement on this important matter—in line with our manifesto—which is disadvantaging many households in Wales. Could Wales learn from Scotland and lead the way in leasehold reform?

Thank you very much. I now call on the Minister for Housing and Regeneration, Rebecca Evans.

Rebecca Evans AC: Thank you, and I'm very grateful indeed to Members for bringing forward this cross-party debate today. As Mick Antoniw set out at the very start of the debate, leaseholders have a long history, but I think our debate today has really highlighted how, in recent years, an unscrupulous minority of developers and freeholders have sought to profit from questionable practices.
I think that the issues that have been discussed fall into three broad themes: the inappropriate sale of new homes as leasehold; the plight of people who have been sold homes on leasehold and are victims of poor practice; and the underlying question as to whether or not leasehold is actually still fit for purpose in the modern housing market.
This particular motion focuses on the first of these themes. Not all leasehold transactions are inappropriate, of course. Leasehold is a valid tenure for flats and apartments, for example, when it's operated fairly. It can ensure that communal areas and maintenance are dealt with on behalf of all the residents. And in the absence of a current suitable alternative, leasehold does have its place in our housing market, particularly given the increasing number of new homes that are flats and apartments. This is why point three of the motion is difficult for us, although I do obviously agree with the spirit of the motion.
Contributions today have again highlighted that there are those out therewho will neither use leasehold appropriately or operate it fairly, and the concerns, really, are many, complex and varied, and we've heard so many examples of them today. All too often, I think that they do relate to leaseholders feeling that they've been misled or that they face excessive or escalating charges, and we also hear of difficulties when seeking to buy those freeholds, extend leases, and we hear of leaseholders feeling that they are receiving poor value for money or a poor service. So, I want to put on record today my commitment to exploring what can be done to address these issues, recognising the complexity and the technical nature of the issues.
But, turning to today's motion, we are all aware of the recent high-profile cases of new-build houses being offered on a leasehold rather than a freehold basis without any clear justification. The data shows that the proportion of new houses sold as leasehold has increased in recent years and I want to put an end to the inappropriate use of leasehold for new-build houses in Wales. There are a small number of sound reasons for houses to be sold on a leasehold basis, and these include the sale of new-build developments on land owned by certain bodies that have a long-term interest in land, such as university bodies or the National Trust, and that, specifically, is what we're talking about when we're talking about the phrase 'absolutely necessary'.
But, beyond this, I see little reason for houses not to be offered for sale on a freehold basis. I do recognise the need to act with urgency, and since coming into post I've identified a number of key improvements, which are to be taken forward immediately. I've already opened up discussions with developers in Wales through our house builders engagement programme and I've made it clear that it is my desire to limit the number of new properties that are sold as leasehold and that my preference is for leasehold to be limited to premises such as flats where the structure of the building and the need to ensure there is maintenance of common areas does necessitate it. I want all house builders operating in Wales to publicly pledge not to sell new-build houses as leasehold in Wales, except in those exceptional circumstances that have been mentioned, and Jane Hutt kindly named some of those developers who have already made that commitment. I'll be using the tools currently at my disposal—

David Rees AC: Will you take an intervention, Minister? On that basis, will you also reassure that, the right to actually—if they decide to sell it on, even in those exceptional circumstances, if they decide to sell it on, the leaseholder has the first call on purchasing the freehold before they sell it to somebody else?

Rebecca Evans AC: The leaseholder should always have the first opportunity to purchase that lease, but it is my concern that, often, the price of the leases are beyond what the leaseholder is able or the home owner is able to pay for that lease, and that's something that I would be looking to explore in the wider context of this debate.
But I am really keen to be using all of the tools currently at my disposal to reinforce my commitment to this agenda, so I will be shortly be announcing a package of measures through Help to Buy—Wales to this end and it is my intention to bring forward these measures quickly. The plans are at an advanced stage, and I look forward to sharing further detail on those soon, but they will respond to some of the issues and concerns that we've heard during the debate.
Early engagement with house builders on these proposals has been very positive and I am confident that we can work with the industry in Wales on this. Secondly, I also want to improve awareness of what it means to hold a lease, and this responds to one of the key concerns that was raised by Lynne Neagle, along with Jane Hutt and Gareth Bennett, during the course of the debate. In those cases where it is right for a property to be sold as leasehold, such as a flat, for example, it is absolutely vital for potential purchasers to be completely familiar with the terms of the lease and able to challenge anything disadvantageous in it at the outset.

Mick Antoniw AC: Will you take an intervention? Do you agree with me, though, that, although it may be a matter of engaging with UK Government in terms of what our devolved powers precisely are on that, the concept of commonhold is really the aim we should be heading towards—proper commonhold—and an absolute end towards the concept of leasehold, which is, essentially, a property owner's device?

Rebecca Evans AC: Commonhold is a model that I've been looking at, and I've been trying to understand why commonhold hasn't taken off in the past, what have been the barriers to it succeeding previously, and what could be done differently in future as part of that wider contextof how to improve leasehold and so on, and freehold, within this particularsector.
I'll be developing awareness-raising materials and bespoke training to be made available to all of those involved in both buying and selling of property, and thatincludes leaseholders, estate agents, managing agents, conveyancersand freeholders, and I'vealready asked officialsto set up a multidisciplinarytask and finish group to expedite this piece of work.I also intend to put in place a voluntary code of practice to underpin these measures. This will help improve standards, promote best practice, and improve engagement between all parties. It will also set out clear expectations for leaseholders, freeholders and managing agents and will be of particularinterest to those managing or living in homes where there is that need for joint management of communal areas and maintenance.
So, these are some of the things that I am taking forward right now, and I do believe that they will have an early and positiveimpact. But I do acknowledge that they are very much only part of the picture. So, I'm not shying away from the more fundamental issues around the future of leaseholdas a tenure and alternatives that may be more appropriate in the modern housing market, such as commonhold, for example. Neither am I ruling out the possibilityof legislation if workingtogether with the industry fails to deliver the improvements in the practice that are so clearly needed. I will be measured and base my decisions on the solid evidence.
That is why I've taskedofficials with commissioning research to understand the detail of some of the more complex issues around enfranchisement and the buying, selling and extensionof leases as they specifically relate to Wales. I'veasked them to engage with stakeholders as well, and this very much responds to that final ask that Mick Antoniw made in his speech at the start of the debateas well. It's also why I'm engaging with the Law Commission and their planned review in this area, and I think that will help answer some of those questions about competence. Because, of course, the answer often depends on the question that you ask in terms of competence, becauseso many of theseareas do straddle areas of responsibility. But that piece of Law Commission work that we're engagingwith I think will be particularlyilluminating and useful.
I'm also keen to see what we can learn from other parts of the UK, including England, which faces similar challenges, but also keen to see what lessons we can draw from Scotland. Again, we've heard a little about the approach there, where they've taken a very different direction to tenure for properties with shared facilities.I do recognise, though, that even future legislative reform may offer little to those who feel that they have been unfairly treated in the past. This is why I've asked officials to work closely with LEASE to identify how existing leaseholders might be best supported. So, the measures I've spoken about here today and the further detail I'll be announcing very shortly can be delivered in the very short term without the need for legislation. That doesn't mean that I'm ruling out the need to consider futurelegislative options, but it does reflect my desire to act quickly where I can whilst we do that groundwork on which to base any wider reforms.

Thank you. Can I call on David Meldingto reply to the debate?

David Melding AC: Thank you, Deputy Presiding Officer. Can I just say that serving in the fifth Assembly is a great honour? When I compare it to the fourth Assembly, two things standout: (1) the Deputy Presiding Officer's got much better—[Interruption.] Yes, we're very lucky. But, secondly, the way these debates are being used has brought a new dimension and a new power to the backbenches. Using this individual debate to generate cross-party support for a real issue of great concernto the peoplewe represent I think is just fantastic.
Can I start then with Mick Antoniw? And, just talking about how many leaseholders thereare out there—200,000 at least—he said a review of this whole area is well overdue, becauseat its heart often lies profound unfairness, and, in very vivid historical terms, talked about the eleventh century and a propertyowners' charter. It was slightly imbalanced in that thereare some uses for leasehold, but, generally, the way it's had a renaissancerecently, it is really troubling. You did say that existing legislation, the 2002 leaseholdreform Act, has not really stood the test of time in doing what really is now needed.
He called for (1) urgent temporary steps—and I think the Minister may have satisfied us a bit there—and then, second, legislationto ban leasehold in most cases—there are some communal living options, such as apartments and flats, that may still require leasehold—but to ban it, really, in most cases here and to have our own legislation, which I thought Jane Hutt, then, echoed at the end, saying, 'We should lead the way in reform'. Perhaps that's the big idea that you shouldn't rule out at this stage, Minister, and I'm pleased that you are going to talk to the Law Commission about this.

David Melding AC: Then Mick said that the practice for existing leaseholders needs to be examined. Again, I think the Minister did indicate that that's a real concern. So, I thought, in general, where you started is where the other Members then took us in more detail, and then the Minister broadly, I thought, did reply to most of the points.
Janet Finch-Saunders mentioned the action, or the intentions, that have been expressed by the UK Government, and there's this whole issue about how much power we have in terms of the Wales Act, but I think we should certainly seek to act quickly. We don't need to follow the UK Government, and the UK Government hasn't yet actually brought its own legislative proposals forward, although I hope to see them soon.Janet talked about this new phenomenon of leaseholds being used for new build, which was a central part of the debate. She also mentioned, when that happens, the lack of information for home buyers—often first-time buyers, perhaps young families, and not quite realising the implications of leasehold and what that would bring.
Lynne Neagle talked about a slightly different issue—which I think was hugely important, actually—those who have purchased social housing, or what was social housing in the past, and have a leasehold that has quite a strong obligation in terms of maintenance, and where these people are, then, when quite considerable maintenance charges are applied. I think we've all had casework where, often, blocks of flats have extensive exterior renovation, use of scaffolding, new windows and repair to roofs—very, very expensive. These people, I think, are often quite a vulnerable group, and you made some interesting suggestions there, which I'm sure the Minister heard, such as a cap on charges.
Siân Gwenllian then talked about retirement flats and what happens when your residents' association is simply not as active or winds up because you don't have the key people you need to take it on, and then the practices of some management companies to really use that property as a way of getting income out of people. I think that's a real, real concern that many of us have had and have seen the problems—that badly motivated maintenance companies have resulted in really quite a bad situation for those tenants.
David Rees then reminded us that this is not a common way of ordering land ownership around the world. We, unfortunately, seem to be stuck in a somewhat feudal practice. You did say—I thought this was interesting, because it's what I've heard as well—that there's no great price difference when you buy a new home on leasehold or freehold. I think that's really interesting, because I've even heard of a development in south-east Wales where the developer changed policy halfway through. The price of the houses didn't change, only those who brought early in the development now face additional charges to get their freehold of about £3,000 on average. Now, if you're a first-time buyer, a young family, suddenly facing a £3,000 bill just to get your freehold—I think there's a real, real problem.
Gareth Bennett talked about the 1950s and 1960s. You'll remember the discussions that were even later, back in the 1970s and 1980s, when leasehold reform had bedded in, but then there were still a few more problems coming forward. But it was a real issue in Wales in the 1950s, and it's now come back, so I think we owe it to our constituents to search out that best practice and establish it once and for all.And, again, you mentioned that first-time buyers were particularly vulnerable.
Then, finally, Jane Hutt talked about the waterfront development in Barry. It's an important development and it's typical of some of the more exciting developments that have occurredin the last decade or two. There, Help to Buy has often been used even when there is leasehold tenure. David Rees said that's one thing perhaps we could change, and I think, actually, if we send that sort of signal you'd see the developers change their policy—the ones that have not signed up to your best practice yet would soon shift. That's a thing that we should be doing.
And finally, I'd just like to finish with what Jane Hutt said—that Wales should lead the way, we should reform. We heard what the Minister said. I'm not quite sure everything can be done without legislation. I think we should do as much as possible quickly, but I do think there is probably going to be a need for legislation. Once we can assure ourselves that we have the competence under the new Wales Act, you clearly will have cross-party support to act, and to act quickly. Thank you very much, Deputy Presiding Officer.

Thank you. The proposal is to agree the motion. Does any Member object? [Objection.] Therefore, we defer voting underthis item until voting time.

Voting deferred until voting time.

6. Debate on the Petitions Committee's report on Disabled People's Access to Public Transport

The next item on our agenda this afternoon is the debate on the Petitions Committee report on disabled people's access to public transport. I call on the Chair of the committee to move the motion—David Rowlands.

Motion NDM6643David J. Rowlands
To propose that the National Assembly for Wales:
Notes the report of the Petitions Committee on the petition: Ensure Disabled People can Access Public Transport as and When They Need It (P-05-710), which waslaidin the Table Office on 10 October 2017.

Motion moved.

David J Rowlands AC: Diolch, Dirprwy Lywydd.I am delighted to open this debate on the Petitions Committee’s report on disabled people’s access to public transport services in Wales. Can I acknowledge at the outset that the Welsh Government's response to the report and its recommendations has been extremely positive?
The petition that led to this report was submitted by young people from Whizz-Kidz, an organisation that supports young people with disabilities, and I want to start by paying tribute to everyone who was involved for their commitment to campaigning for improvements to public transport services in Wales. The young people the committee met with, and those who provided their views to us in a video, helped us to better understand the challenges that disabled people face every time they try to use public transport to go about their daily lives. I thank the petitioners for bringing these issues into focus for us, and warmly congratulate them on the way they have pushed their petition forward.
The petition calls for disabled people to have the same rights to access public transport as anyone else in Wales. One of the young people we spoke to described his aspirations in the following way: 'I’m 13 now, I would like to be like everyone else, go around without telling someone 20 times, so I can get to where I’m going and come back with no problems.'
In their evidence to us, the petitioners outlined their experiences with a range of public transport and raised a large number of issues. These included difficulties travelling at short notice or when it is not possible to request assistance in advance, and poor infrastructure, which can prevent people from travelling at all. There was also a lack of support from some staff, which can make people feel vulnerable or burdensome. The committee heard that these problems can make it more difficult for people to access education, employment and social opportunities. This can have a major impact on people’s independence, confidence and self-esteem. A number of petitioners mentioned that they wanted access to public transport on demand, not having to book some time in advance. They wanted to turn up and go, the same as their able-bodied friends.
The petitioners have described their experiences of using trains, buses and taxis. As a result, we held evidence sessions with organisations involved in providing these modes of public transport. We would like to thank everyone involved for the evidence they provided. Full details of this work is naturally contained in our report. Having heard this evidence, we made 12 recommendations. Time will not allow me to speak about all of these today. However, suffice to say, we concluded that improvements were required across all modes of public transport, and I wish to highlight some of our key recommendations.
In relation to rail services, we believe that improvements need to be made to stations, trains and the support provided by staff.In our report, we recognise that elements of this are not devolved or are currently in the process of being devolved.Nevertheless, there is clearly a lot that the Welsh Government can do, and I particularly want to highlight the opportunity the Welsh Government currently has through the process to award the next Wales and borders rail franchise. The potential exists to ensure that the next franchise agreement contains requirements for significant improvements to be made to the accessibility of rail services, which would benefit people across Wales. The Petitions Committee has also proposed that accessibility should be included as a performance measure in the next franchise, and I am pleased that the Cabinet Secretary has accepted our recommendations on this.

David J Rowlands AC: In the evidence we received from Arriva Trains Wales and Great Western Railway, we heard about the positive policies that are already in place. These included the ability for disabled passengers to request alternative transport to another station when the closest one is not accessible, or when, for example, lifts are out of order.However, our conversations with the petitioners, who are all frequent users of public transport—and indeed many rely solely on public transport—convinced us of the need to better promote the assistance already available.
In many ways, the issues the petitioners raised around bus services were similar. Again, we heard about good policies but had concerns that these did not seem to be reflected in the real world experience of disabled passengers.Some of the problems identified by the petitioners included the reluctance of some drivers to deploy ramps or to lower buses to kerb height, lack of time or patience allowed for passengers to get on and off safely, and drivers not stopping in suitable locations—for example where there are raised kerbs. The committee appreciates that this last issue is sometimes beyond the control of bus drivers due to other vehicles blocking access to bus stops. We also recognise that drivers face a range of pressures, not least of which is to meet timetables. These issues have recently been considered in depth by the Economy, Infrastructure and Skills Committee, and they clearly represent significant barriers for disabled passengers.
We also heard some good examples of training practices carried out, including by Cardiff Bus and FirstGroup. However, we were concerned that not all companies apply the same standards through driver training, and we concluded that the Welsh Government should consider making a specific disability awareness module a mandatory element of the certificate of professional competence that drivers working in Wales must achieve. We are pleased that the Welsh Government has accepted this recommendation and others we made relating to bus services.
Finally, we considered taxi services. Up to now, the Assembly has possessed limited powers over the operation of taxi and private hire vehicle services. However, the Wales Act 2017 is devolving more of these powers. We were encouraged to hear about plans the Welsh Government has to update the licensing and registration regime.In particular, we believe that the Welsh Government should press ahead with the development of common national standards for all taxis and private hire vehicles. All the witnesses we heard from shared the view that the current regime is outdated and that we should strive to achieve greater consistency across services.
The committee’s intention in making this recommendation was to respond to a number of problems highlighted by Whizz-Kidz. It was clear that disabled people’s experiences of taxi services vary significantly across Wales, and between different companies and drivers.Some of the experiences that were related to us were clearly way below the standard that disabled people should be entitled to expect. These included drivers not strapping wheelchairs into vehicles, drivers starting the meter running whilst helping passengers to board taxis or to stow mobility aids, and companies refusing to accept bookings from passengers they know are disabled. We, and all the witnesses we heard from, were clear that such behaviour is unacceptable and may in some cases breach existing law.Nevertheless, we also concluded that greater clarity over the standards of service that passengers expect would be beneficial to disabled passengers and, in fact, everybody who uses taxis.
In summary,I hope that the committee’s work on this petition has contributed to identifying both why and how real improvements to the way disabled people experience public transport could be achieved in Wales.It is right to say that the Assembly or the Welsh Government cannot, currently, do all it might want to do to achieve a fully accessible public transport system. However, there is much that can be done to improve the real-world experience for people with disabilities. Much of this will require good partnership working with councils, operators and disabled people. It will also require good leadership from the Welsh Government. Our evidence session with the Cabinet Secretary for Economy and Transport, and the Welsh Government’s response to our recommendations, has given us encouragement about the commitment that exists to make the required improvements.

Mike Hedges AC: I very much welcome the opportunityto debate the Petitions Committee report on ensuring access to public transport for disabled people. This was a classic example of what organisations expect to happen when you talk to people at the top of the organisation and what actuallyhappens when disabled people try and access transport. And I think David Rowlands gave some examples of what we were told about how you could get a taxi to the next station—when I mentioned that to some disabled people, they looked at me in bewilderment.
I was Chair of the Petitions Committee when Whizz-Kidz gave their evidence. Can I, as I did at the committee—but I'd like to do it now, on the record here—thank Whizz-Kidz and congratulate them for coming along to give evidence to the committee? It's not an easy thing to give evidence to a committee, and I know how nervous a lot of older adults from organisations get when they have to come and talk to committees. These were a group of young people, but they had their beliefs that they needed to get their point over, and they certainly did.
Whizz-Kidz presented problems around access to train, bus and taxi services to the committee. These problems included: the inabilityto travel at short notice; a lack of staff training across all transport modes, which results in disabled people being made to feel like a burden or being unable to travel at all; a lack of support on trains and issues with the accessibility of trains and stations, including when lifts are not working. Whizz-Kidz also highlightedthat accessibility issues can impact on a young people's ability to look for work and socialise, as travelling can be too much of a hassle—it's too much of a problem, it's too difficult. These issues can also impact on young disabled people's confidence, leaving them feeling isolated, and meaning that they don't feel equal to their peers who do not use wheelchairs.
Whizz-Kids provided the committee with video evidence, which included Josh's story, which highlighted many of the barriers facing young disabled people when travelling by train in south Wales. This was on the Petitions Committee site; I think it probably still is, if it isn't, can I ask, Deputy Presiding Officer, if we can make it available from here, so that people can access it? Because it really does tell the story from the position of a young man trying to access trains.
Concern was also expressed regarding the ability of people with hearing and sight loss to use public transport safely. For people with sight loss, a simple thing that could help them is the driver of a bus telling them when they get to the place they want to get off. That's a very simple thing, it doesn't need legislation, it's just good practice that should exist with bus companies. A lot of these things here that we're asking for and we need are not legislation, but good practice.
The train and bus operators that gave evidence to the committee outlined the varying levels of disability awareness training provided to staff. There is currently no mandatory requirement for bus operators to require drivers to complete disability awareness training. However, First Cymru said that all bus companies were required to provide disability awareness training from 1 March as part of the driver certificate of professional competence. But, training is only of benefit if it is acted upon. It is necessary for bus companies to ensure thatdrivers carry out what they've been trained to do. It's pointless telling them during a training session of three hours that they've got to do things if the next day they ignore it.I attended a dementia training session with First Cymru a few years ago. The training was very good, but it needs to be acted upon, and in First Cymru's case in Swansea, it has been.
The accessibility of trains and stations was also examined by the committee. The train operators stated that whilst new trains are accessible, older trains aren't. Concern was also raised around the availability and accessibility of taxis and private hire vehicles, especially at certain times of the day. The Licensed Private Hire Car Association said that, as most drivers are self-employed, taxi operators and licensing authorities cannot demand that drivers of certain vehicle types are available at certain times of day.ButI think that there are ways of ensuring we get enough vehicles that can take people with guide dogs or take people in wheelchairs so that there will always be one available.
To me, the clear recommendation is: introduce disability awareness training for customer-facing train and station staff under the new Wales and borders franchise, bus drivers as part of the voluntary Welsh bus quality standard, and taxi and PHV drivers. [Inaudible.]—anyone who discriminates against disabled people out of prejudice, but we need training. We need to make sure our training is implemented. With no lack of will with the leaders of the organisations, what we need is an improvement on the implementation at operational level to ensure that what organisations think is happening, what we want to happen and what disabled people need to happen actually happens when somebody tries to access a vehicle. Thank you.

Rhun ap Iorwerth AC: Thank you very much, Deputy Presiding Officer. I'm pleased to be able to take part in this debate, which stems from the report on this petition. I wasn't a member of the committee when this petition was being considered, but I do know, from experience of discussing with constituents and with different bodies, the problems that do face disabled people as they try to use public transport.
As it happens, I'm meeting tomorrow with a crew from Citizens Advice and the Taran disability forum in my constituency to discuss public transport and accessibility to public transport with them.I will be pleased to share with them the responses and the comments that have been made in the Assembly today, and the response from the Cabinet Secretary as well. The reason that they have contacted me is, as part of the project from Citizens Advice, to help specific groups to be able to have their say on issues that affect them. Transport is one of those things that genuinely does affect people with disabilities.
I'm very pleased that that's what Whizz-Kidz have done: they've had their say by bringing the petition to the Assembly's attention. I'd like to thank those young people from Whizz-Kidz, not only for presenting the petition itself but also for the way in which they, as we heard from Mike Hedges, responded to the challenge of giving evidence face to face in the committee itself. As I said, I wasn't part of the inquiry, but the video is there for you to be able to watch, and, certainly, the young people need to be congratulated for the way in which they can make their point in such a eloquent way.
They mention their experiences with taxis, buses and trains, and that they can't travel at short notice and they have to give 48 hours notice to have the train ramp, for example, and that they feel under pressure to get off public transport because they're aware of the bus wanting to leave and that drivers aren't always aware of how to put a wheelchair on the vehicle. There are multiple problems.
Those problems, taken together, make these people feel like they're a burden and that they are not equal with their peers who don't have wheelchairs and who don't have to face these problems while travelling. It does affect their confidence, and it can have an effect on their ability or their willingness to look for work, even, or to socialise. There is a risk, therefore, that they can feel that they're being isolated. That ties in with the work that we've been doing in the health committee as we look at loneliness and isolation. The evidence that we had as part of our inquiry there suggested that isolation and loneliness could have a significant impact on the mental and physical health of individuals. The British Red Cross says this:

Rhun ap Iorwerth AC: ‘A lack of social connections can be linked to cardiovascular health risks and increased death rates, blood pressure, signs of ageing, symptoms of depression and risk of dementia. It could be as damaging to health as smoking and as strong a risk as obesity.’

Rhun ap Iorwerth AC: So, we're talking about something here that can have a very detrimental impact.
Even though we have focused in that inquiry on older people, disabled people and young people were recognised as two other groups who are vulnerable in terms of isolation and loneliness, and we heard that transportcan be a factor in that.We had evidencethat the barrier of having to plan journeys beforehand prevents travellers from making their journeys, and means that travelling at short notice is almost impossible. Of course, young disabled people, like their peers, want to travel with their friends, and they want the opportunity to travel without having to plan in detail days beforehand. This doesn’t fit the lives of young people, very often, and they want to feel that they can be confident that they can travel without feeling that they’re a nuisance to other people.
I’m very pleased, therefore, that the Welsh Government has accepted all of the recommendations by the committee, including giving staff the training to help them to create a supportive, inclusive and accessible environment, and that they will work with groups that represent disabled people to develop that very important training. So, the input of groups such as Whizz-Kidz and Taran—who I’ll meet tomorrow—I’m sure will be of great help to the Government with that work.

Thank you. Janet Finch-Saunders.

Janet Finch-Saunders AC: Thank you. I'm thrilled to be able to contribute to this debate. I'm actually enjoying my time on the Petitions Committee, because I've been surprised, really, just how many people do take that Petitions Committee seriously and actually feel that they can engage with the democratic process here. But I have to say, one of the best evidence sessions of any committees that I've been on in the two terms that I've been an Assembly Member was certainly this one, because it was a real eye-opener, and it is was a delight to meet so many impassioned and inspirational young activists from Whizz-Kidz, and not only to hear their stories, but, actually, with the video that they provided, and the engagement that we had with them, the conversations we had informally and then formally, through the evidence that they submitted to committee—it was fantastic.
Now, this petition seeks to ensure that disabled people are able to access public transport, and for me, that means all methods of public transport, when required and without the need to plan assistance 24 hours or even more in advance. I think it's safe to say that we can all agree that, in this day and age, such an ambition shouldn't just be perhaps achievable, it should be a given.
I note the acceptance of the Welsh Government of all the recommendations we have set out in this report, but I would further like to press the Cabinet Secretary for a little more clarification and detail on a number of points. Would you outline how the Welsh Government might work to examine the feasibility of supporting the use of an orange wallet-style assistance scheme in taxis and private hire vehicles in Wales, in addition to looking at this for bus services? In fact, I think we should have some kind—without putting any discrimination on or labelling people, I do think that, if there is a belief in an orange wallet-style assistance scheme in taxis, private hire vehicles, buses and trains, then we should be looking at that.
How will you work with interest groups and operators to develop training for customer-facing staff under the new Wales and borders franchise to ensure that disabled people will be able to just turn up and go on railway services in Wales in the future? What does the Cabinet Secretary estimate the cost will be for this development and the undertaking of accessibility awareness training for bus drivers across Wales, as noted in the report, and his acceptance? How much of this is intended to be provided by the Welsh Government and how much by the bus services support grant?
Finally, the importance of audio and visual announcement systems on public transport was stressed by practically everybody in our evidence sessions, and I have to tell you, whilst this is to do with a petition now for disabled access, I find it difficult, especially at nights when the trains are dark and things. Sometimes the announcements aren't easy, so if I struggle, then it should be an absolute given that people can actually hear and see exactly where they are, and when they need to depart the train, so that, again, they can be prepared, and so that there's no risk of accident. What did worry me in a lot of the evidence we took was not so much how inconvenient it was to access public transport, but that they felt that it was dangerous on occasion, and that they felt a nuisance. They felt unsafe as well at times,and I think that's a sad indictment, really, when you think how we are able to get around so easily. Bus service operators assured us during evidence that they ensure that they will acquire into their new vehicles audio and visible announcement systems. But I really want you to work with the industry, Cabinet Secretary, to ensure that this becomes a reality.
You mentioned utilising the support and the financial resource that we have, and I wonder what commitment you are able to make today. Accessibility to public transport for all must be a right, not a privilege, and is essential to working towards a more prosperous and greener Wales.
I welcome and I applaud the tenacity and determination of the young petitioners in bringing this issue to the fore of the agenda here in the National Assembly for Wales. I hope that easy use of public transport will be universal here by the end of this Assembly term. Well done to everybody who presented and brought their evidence to us from Whizz-Kidz. Thank you.

Mark Isherwood AC: The petition submitted to the Petitions Committeeby Whizz-Kidz rightly calls for disabled people to get the right to access full public transport when required—a call I first heard some 15 years ago on the Equality of Opportunity Committee, something we've all sequentially signed up to, and yet, we are we are.
In his response to the Petitions Committee report, the Cabinet Secretary for Economy and Transport said he looks forward
'to working with the public transport sector, our local authorities and most importantly, disabled and older people to renew our efforts to transform our public transport into an inclusive and accessible network'.
And, clearly, amen to that. However, whilst accepting the Petitions Committee's recommendations, much of his response then amounts to 'steady as we go'.
On recommendation 1, he accepts that, but then goes on to say that
'The Welsh Government will continue to encourage public transport operators to adopt the “orange wallet” scheme'
for bus and rail users across Wales. So, it's really to continue doing what we're doing. That recommendation also included calls for him to
'examine the feasibility of supporting its use in taxis and private hire vehicles.'
There's no reference to that whatsoeverin his acceptance of the recommendation that he has then failed to address. And this is particularly critical, given that last October, Disability Wales's findings, reported by BBC Wales, was that some taxi services in Wales were refusing to pick up passengers who use wheelchairs or assistance dogs, leaving them stranded and humiliated. Disability Wales then called on the Welsh Government to strengthen the laws againstdiscriminating against disabled people.
He accepts recommendation 3, which is calling on work with train operating companies to
'raise awareness of support available to disabled passengers'.
Again, his response amounts to:
'We will continue to work with the ORR to ensure passenger support is improved.'
Where is the big change required? He accepts recommendation 6 on the Wales and borders rail franchise, rightly saying that a
'Lack of appropriate training of front line staff in the transport sector isoften cited by equality groups as a barrier to accessing the public transport network in Wales.'
And he says:
'We will be working with interest groups and operators to develop training'.
But this avoids the key issue of who will then deliver that training.
Recommendation 11 says:
'The common national standards to be developed by the Welsh Government should include a requirement for all drivers in Wales to complete general disability awareness training'.
In accepting that, he says:
'It is expected that local licensing authorities will ensure that all drivers operating in their areas will undertake training issued by the Welsh Government.'
As I said on Good Morning Wales last Saturday morning, for those of you who are awakeearly, in adopting the social model of disability, in removing the barriers to access and inclusion for all, it's no good sending people on training courses with external consultants or Government training courses, or training courses provided by your line manager. If people are going to really develop disability awareness, they must get that training from the experts, and theonly experts in this area are disabled people themselves.
The National Deaf Children's Society have said:
'We believe that disability awareness training of transport staff in all sectors is imperative and that such training should include basic deaf awareness.'
On a personal level, of course, I would support that, but that must involve people with hearing loss themselves. After a constituent and friend who actually lives in the Cabinet Secretary's own constituency faced problems on a Virgin Trains trip—a constituent and friend who is on the autism spectrum—I took up his case, and the positive outcome from this is that I'm taking him next month to Virgin Trains's talent academy at Crewe station for him to provide an autism awareness training session to their staff. That is the way we need to be going forward.
As Guide Dogs, the charity, say, the UK Government
'have agreed to make all buses accessible to people with sight loss and hearing loss'.
They do credit the Welsh Government for having been the first Government to require operators to install audiovisual next-stop announcements, but they then have asked me to ask you if there are any plans to consult with the UK Government to introduce common regulations and guidance across the two nations, because a lot of bus operators have roots that operate across England and Wales, and, of course, to fail to do so would create more barriers for people with sight loss.
We're running out of time. We've had legislation after legislation, good, well-meaning legislation that's supposed to be about designing and delivering services with people rather than for and to them, and yet we hear horror stories like wheelchair users still being denied access to the coastal path in Flintshire and the deaf community in Conwy having to go to the ombudsman after the council decommissioned their British Sign Language services after the social services and well-being Act; after the well-being of future generations Act; and despite the Equality Act 2010. Come on, we need a big step change. Fifteen years, for me, here, waiting for the big step change is too long to wait and it's decades too long for people with impairments across Wales.

Can I now call the Cabinet Secretary for Economy and Transport? Ken Skates.

Ken Skates AC: Thank you, Deputy Presiding Officer. I'd, first of all, like to thank the Chair and the members of the Petitions Committee for their report, and on behalf of the Welsh Government, I am delighted to accept all 12 recommendations put forward by the committee in today's debate. The way that the debate has been conducted reflects the way that the committee behaved during the course of its inquiry, and I, again, would like to place on record my congratulations to the committee for the excellent work that has been undertaken.
As I said in my written response to the report and the committee's recommendations, the petition that was submitted by Whizz-Kids, seeking action to ensure that disabled people can access public transport when they need it, I think, brought into sharp focus the barriers faced by disabled people when using the public transport network across Wales, and, in particular, the video evidence submitted to the committee in support of the petition was a powerful illustration of the difficulties that disabled people encounter when accessing services that pretty much all of us in this Chamber take for granted.
I'd like to commend Whizz-Kids for the work that they and the Petitions Committee have done to highlight some of those issues. I share the frustration expressed by disabled people and people with restricted mobility when trying to use our public transport system. I did find it quite harrowing at times, learning about the daily challenges that are faced by people who just simply want to be better connected to other people, to other places, to services and to work.
Deputy Presiding Officer, it's my belief that too many train stations in Wales remain inaccessible and that too much of the rolling stock on our network is simply not up to the standard that we should accept in 2018. But, in delivering the Welsh rail services for the future, Transport for Wales will be working with Network Rail and the next train operator to improve access to rail for all people. Change, of course, won't happen overnight, but it must happen.
I welcome the committee's support for our proposals to introduce statutory guidance in relation to the quality of local bus services and for the delivery of local bus infrastructure. We have made some progress in relation to better bus services by using the funding that we provide through our bus services support grant to improve the quality of local bus services as set out in our voluntary Welsh bus quality standards.
Bus operators are installing audiovisual next-stop announcement systems to their buses, and I congratulateCardiff Bus, Newport Transport and Arriva Bus north Wales, who have all made excellent progress over the last four years in this regard. I'd also welcome the decision by Stagecoach to invest in newer, smarter and cleanerbuses that are also fitted with audiovisual next-stop technology.
Bus services are improving and we need to improve our bus infrastructure. I'll be bringingforward detailed proposals in the spring for how we can plan to address these issues in the future, together with how we can improve taxis and private hire vehicle services through a better licensing regime, tailored to meet the needs of the people in Wales—all people in Wales. As I recently announced, I believe it was in October last year, media reports about disabled access to taxis will be addressed. Disability Wales said people are being ignored and being refused cab journeys, leaving them stranded and humiliated—stranded and humiliated. That is something that no person should ever feel when travelling from A to B.
We were told that better training for front-line transport staff is a critical requirement if we are to address the issues we have discussed today. In December, I published a policy statementwith six outcome-focused objectives that are designed to improve access to our public transport network, including organising better training for staff delivering our public transport services. The quality of training is, of course, as Mark Isherwood said, absolutelycrucial. We will make sure that the best quality training is provided to transport services.

Mike Hedges AC: Will you take an intervention?

Ken Skates AC: Yes, of course.

Mike Hedges AC: Training is very important, but making sure that people carry out what they've been trained to do is even more important, isn't it?

Ken Skates AC: Oh, absolutely. It's not just about turningup and being trained. It's about making sure that you apply what you are trained to do on a daily basis and that we actually use trainingas a means of delivering a cultural change in the way that transport is accessed and the way that transport is provided.
But, the objectives that I've outlined in December, and also the actions underpinning them, have been designed by my accessible transport panel, which comprises organisations representing disabled people, older peopleand people with learning disabilities, and of course with equality groups. So, I'm confident that the trainingthat will be provided will be not just adequate, but of the best standard possible. I'm also pleased that Whizz-Kids have contributed to this work.
To take up just a number of points in addition that have been raised, what David Rowlands and Janet Finch-Saunders said about on-demand travel, I think, is absolutelyessential in order to ensure that people can live the most independent lives possible. I think what Mike Hedges and Rhun ap Iorwerth talked about, concerning the threat of living a life that leaves you isolated and lonely, is very real for many people. I was at an event just last Friday, hosted by Citizens Advice, that looked at how transport, better connectivity, can be used to tackle poverty, particularlyin rural areas, and especially in rural areas where thereare people who have limited mobility. It goes back to Maslow's hierarchyof needs. If you're not connected to people and services, then you're more likely to live a life that is distressed and unhealthy, and therefore contributesto strains on the NHS and also prevents the economy from growingas we'd wish.
Also, in terms of audiovisual next-stop announcements, this was somethingthat was raised particularlyby JanetFinch-Saunders. This is a positionthat we have all taken—the position that's outlined in the recommendation—andI believe that it shouldnot be open for negotiation whatsoever. What we use in terms of the bus services support grant is designed not only to improve the quality of bus services for some passengers, it's designed and should be used to improve the quality of services for all passengers. So, those improvements to audiovisual next-stop announcements should and must be pursued by all service operatorsthat are applying for bus services support grant funding.
Deputy Presiding Officer, I do think that now is the time to put our words into action, and now is the time to deliver an accessible and inclusive public transport system that the people of Wales have a right to expect. And now is the time, I think, for us collectively to prevent any person from being left stranded or humiliated by the failure of transportto adapt to the needs of all passengers in the twenty-first century.

Thank you. Can I call on David Rowlands to reply to the debate?

David J Rowlands AC: Yes, first of all, can I thank all the Members for their contributions to the debate and the Cabinet Secretary for his positive response to the petition and the committee's recommendations?
Mike Hedges mentioned the courage of Whizz-Kidz in giving evidence to the committee, and reiterated many of the points in the report, but added that disabled people often decide not to go out for fear of using public transport. He also mentioned the training of drivers, operators, et cetera, and the difference between the theory and the on-the-ground delivery of that training regime.
Rhun ap Iorwerth gave us feedback from his constituents over the years and from his engagement with disabled people in his constituency. He mentioned that because they cause delays, disabled people feel that they're a burden on travellers, leading them not to use public transport, causing, of course, isolation and loneliness. Rhun also mentioned that there should be an on-demand situation for disabled people.
Janet Finch-Saunders voiced her admiration for the presentations, both in person and on video, to the committee, and asked about the orange wallet-style assistance scheme. She also raised the importance of audio and visual aids on all forms of transport, particularly on railway stations. Access should be a right for disabled people.
Mark Isherwood stated that this has been an ongoing problem for a very long time, and he made the point that he thought that the Welsh Government was not really engaging with the recommendations made by the committee. He mentioned at length a desire to have disability awareness training, and the need to have cross-border collaboration to deliver the access required.
Cabinet Secretary, I thank you for your congratulations to the committee for the work that we have done in producing this report. Ken spoke of how powerful the engagement in the process of investigation had been in identifying the problems faced by the disabled. The Cabinet Secretary mentioned the improvements already made, but acknowledged that there was a great deal more to do. I thank him for his extensive outlining of his plans for addressing the problems in the future.
In summary, I want to end by reiterating the committee's thanks to the petitioners for submitting the petition, and for the powerful and moving evidence they provided to us. We hope that the next few years will see real improvements made to improve the experience for disabled people on all modes of public transport and across all forms of disability.

Thank you. The proposal is to note the committee's report. Does any Member object? No; therefore, in accordance with Standing Order 12.36, the motion is agreed.

Motion agreed in accordance with Standing Order 12.36.

7. Debate on the Children, Young People and Education Committee report on Perinatal Mental Health in Wales

We move on to item 7 on our agenda this afternoon, which is a debate on the Children, Young People and Education Committee's report on perinatal mental health in Wales. I call on the Chair of the committee to move that motion. Lynne Neagle.

Motion NDM6642Lynne Neagle
To propose that the National Assembly for Wales:
Notes the Children, Young People and Education Committee Report on Perinatal Mental Health in Wales which waslaidin the Table Office on 17 October 2017.

Motion moved.

Lynne Neagle AC: Thank you, Deputy Presiding Officer. I'm very pleased to open this debate on the Children, Young People and Education Committee's report on perinatal mental health. Perinatal mental illness affects up to one in five women in Wales. With around 33,000 births a year, that means up to 6,600 women in Wales encounter mental health issues caused or worsened by pregnancy or childbirth every year.
Perinatal mental illness is not rare, it is not strange and it is not something to be ashamed of. We also learned that it's not only mothers who are affected—partners can also suffer, as can members of the wider family who seek to support their loved ones both emotionally and financially during periods of ill health.

Lynne Neagle AC: The underlying reason our committee chose to consider this topic is the fact that perinatal mental illness can have an effect on children. It has been proven that the first 1,000 days of a child's life, from pregnancy through to a child's second birthday, is a critical window of time that sets the stage for a person's development and lifelong health. It is a period of enormous potential, but also of enormous vulnerability. A strong bond between a baby and their primary care giver is developed through positive and responsive behaviours. As a result, poor parental mental health can have a significant impact on children's health and development.But it needn't be all doom and gloom. People do come through this. In fact, those who gave evidence told us that, with the right care and support, women can make a full recovery and lead fulfilling family lives.
So, what did we find? We learned that, for the majority of women, care in a community setting will be the mostappropriate. Delivered effectively, it will enable mothers to remain close to their families. Community care can play a vital role in intervening early, preventing the deterioration of mental illness in perinatal mothers, reducing the need to travel for care and alleviating demand on hospitals.
During the course of our inquiry, we discovered that the £1.5 million invested by the Welsh Government in specialist community perinatal mental health services two years ago is bearing fruit. By now, all health boards have established teams that, for the most part, are operational. However, the evidence we gathered showed that variation in service provision clearly still exists between and sometimes even within health board areas. The support available to women with perinatal mental illness can vary significantly.
While we commend the efforts that have been made to establish the new teams across Wales and recognise the significant commitment of the staff who are working hard to roll out and deliver high-quality services, we concluded that the current variation is not acceptable. We heard of significant waiting times for certain services, particularly talking and psychological therapies. We also heard of demand outstripping supply.
We recognise that specialist community teams have only been in place for a short time, and we welcome the progress made to date. However, based on what we've heard, we believe that services in Wales do not currently meet in an equitable or comprehensive way the needs of women at risk of or experiencing perinatal mental illness. We believe that timely and high-quality services should be an expectation and a right for all women, not depending on where they live. As such, we make a number of key recommendations relating to this area in our report.
Firstly, we recommend that more funding needs to be provided to bring all specialist community perinatal mental health services up to the standard of the best. In recommendation 9, we state our belief that the primary aim for the allocation of this additional funding should be to address the disparity in service provision between health boards in Wales. We are acutely aware of the financial constraints facing the NHS at the moment. However, we firmly believe that an invest-to-save argument can be made for this additional funding, based on the costs of perinatal mental illness.
We were told that, across the UK, for each year of birth, the cost of perinatal mental illness to the NHS is £1.2 billion. The estimated long-term cost to UK society as a whole is £8.1 billion. It should not be a question of whether we can afford to invest in these services, rather, can we afford not to. We note that the Cabinet Secretary has accepted this recommendation in principle, and refers to the additional £20 million allocated to mental health services over the next two years. While we welcome this, we would welcome further assurances from the Welsh Government that this funding will be used to address the gaps in perinatal health services when health boards come to allocate that funding.
We were particularly concerned to hear about the lack of psychological support across Walesfor pregnant women and new mothers experiencing mental health problems. We heard how helpful it could be, whether delivered individually or as part of a group. Recommendation 10 states that the Welsh Government should ensure the work it already has under way on this to improve access to psychological therapies for perinatal women, and men where necessary, is prioritised, given the established link between perinatal ill health and a child's health and development. We welcome the Cabinet Secretary's acceptance of this recommendation, and will follow progress on its implementation closely.
Unfortunately, for some women, care in the community is not an option. It is estimated that as many as 100 women a year in Wales will suffer symptoms so severe that admission to an in-patient unit will be necessary. Following the closure of Wales's only mother and baby unit in 2013,we heard that some Welsh womenwere having to travel as far as Derby, London and Nottingham for this treatment and others were being treated in adult psychiatric wards separated from their babies. We concluded that this was wholly inadequate.

Lynne Neagle AC: While we accept that the most specialist of services will sometimes require patients to travel, our report is clear that mother and baby unit provision needs to be developed in Wales. Recommendation 6 called on the Welsh Government to establish a mother and baby unit in south Wales, commissioned and funded on a national basis to provide all-Wales services and adequately staffed in terms of numbers and disciplines. However, our seventh recommendation acknowledges that a unit in south Wales will not necessarily be suitable for mothers and families in mid and north Wales, for example. As such, we call on the Welsh Government to engage as a matter of urgency with NHS England to discuss options for the creation of a centre in north-east Wales that could serve the populations on both sides of the border.
While we welcome the Government's acceptance of these recommendations, we are disappointed that it still remains unclear what the model of in-patient care in Wales will be, and we are also concerned that the data we requested on the level of demand for in-patient care has not yet been published, and we hope to hear more about this in the Cabinet Secretary's reply to the debate.
I'd like to move on now to discuss awareness of perinatal mental health. It was clear from our inquiry that this remains poor among the public and health professionals. Front-line staff, including midwives and GPs, reported feeling ill equipped to identify and treat maternal mental illness. Therefore, we recommended that the Welsh Government undertake a public awareness campaign to improve understanding of perinatal mental health and the symptoms. We are disappointed by the rejection of this recommendation but look forward to hearing more from the Cabinet Secretary in his reply about the public education approaches he believes will be most effective in achieving the levels of awareness we think are crucial if we are to reduce the high level of stigma reported to us during our inquiry.
The need to improve identification of perinatal mental illness and increase communication between professionals to ensure that vulnerable patients are identified quickly and receive the continuity of care they need were also key themes. We are pleased the Government has accepted in principle our recommendation that every health board should have a specialist perinatal mental health midwife in post to help with this and that health professionals likely to encounter these issues receive pre-registration training and continuing professional development on perinatal mental health, and we look forward to hearing how this work will be taken forward.
The importance of bonding and attachment was a key theme that emerged in the inquiry. We were told that, if secure attachments are not established early in life, children can be at greater risk of detrimental outcomes, including poor physical and mental health and low educational attainment. We are disappointed that the Cabinet Secretary rejected our three recommendations in this chapter. We believe our suggestion of a specialist health visitor with a focus on perinatal and infant health warrants further consideration. We also believe that further consideration of the impact of feeding on perinatal mental health is crucial. The Cabinet Secretary's response that there's currently conflicting evidence in this area is the very reason we called for further work to be undertaken, and we urge him to look at this again.
Finally, the use of medication during pregnancy was a key theme arising in evidence. We believe this is an area in significant need of attention for the benefit of both professionals and patients alike. The final chapter of our report begins a conversation about the link between mental health and health inequalities. It is clear that the perinatal period offers a particular opportunity for safeguarding well-being in the long term. We believe a more concerted effort to reach more vulnerable groups is required and further research is needed to identify the best mechanisms for early identification and treatment of populations in greatest need. We are pleased the Cabinet Secretary's accepted our recommendations and we look forward to monitoring them.
In drawing to a close, I would like to acknowledge the enormous contribution of the charity and voluntary sector in the field of perinatal mental health and in supporting neonatal and bereaved parents. It was clear from what we heard that it is often the third sector that identifies gaps in service provision and goes on to fill them. Without the third sector, many important services simply wouldn't exist. A number of our recommendations relate to this, not least our call for more to be done to provide funding for, and raise awareness of, these services. We think this will enablethe statutory and third sectors to join together to provide integrated clinically- and cost-effective interventions. We also echo the calls made by specialist charities for revised neonatal standards to be published. It has taken too long for these to be issued and I want to emphasise to theCabinet Secretary the need for these long-awaited standards to be published as soon as possible.
I would like to close by thanking all the organisations and professionals who've engaged so actively with this inquiry, but also to thank all those with lived experience who so willingly shared their views with us and whose experiences have been so vital to thecommittee's work on this. Thank you.

Thank you. Darren Millar.

Darren Millar AC: Thank you, Deputy Presiding Officer. Can I thank the Chair for an excellent opening speech and for doing such a good job of chairing this important piece of work as we embarked on the committeeinquiry? Can I also put on record my thanks to the clerks of thecommittee and the advisers to the committee as well, for their support throughoutits course?
As the Chair has quite rightly said, having mental health problems during pregnancy is nothing new: one in five women will experience them. In spite of this, I think we were quite disappointed and disheartened, really, that there was a very low level of awareness amongst some of those front-line members of staff as to what to do when some women were presenting with mental healthproblems during birth or immediately after pregnancy. That's why I think those recommendations, particularly about upskilling the front-line staffing workforce, having somespecialist posts so that they can be a resource to thewider team, are so very important and vital.
In terms of themother and baby units, there was some debate, of course, about the need for a mother and baby unit in south Wales, but it was pretty obvious that there was going to be a need for one. In respect of northWales, of course, it is much more complex, because of the sparsity of the population. We were told, as a committee, that the only beds available at present—the nearest ones to those people in north Wales who need them—are over the border in Manchester. But I think it is important that the Welsh Government should actually give consideration to providing resource based in north Wales—which could be accessed by people from thenorth-west of England—in order to improve access for mothers and babies. Becauseit was quite obvious from the evidence that we received from mums who'd been there and gotten the T-shirt in terms of poor perinatal mental health, who required an admission into a mother and baby unit, the fact that it was some distance away had discouraged them and deterred them from making the important decision to actually go there, even though all of theevidence that we received pointed very clearly to the fact thatthere are much, much better outcomes for mums and for their children if a mother is admitted into an appropriate setting in a mother and baby unit rather than in an adult psychiatric ward and is then being separated from their child.
The predictability of the need, we were told by the statisticians, is pretty clear: there are always going to be, based on our population and birth rates, somewhere between 45 and 65 mums per year who are going to require admission into these sorts of wards. Now, becauseof thepopulation in north Wales, we're talking very small numbers. We're talking a handful, a dozen at most, in the region that might need access to these things, but that doesn't mean that we shouldn't be trying to provide within the region if at all possible.
I think that one thing that I was pleased that the Cabinet Secretary referred to is thatthe Welsh Government is making more of an effort to engage with some of the commissioners over the border in England in terms of trying to have a discussion about where it might be possible to base these sorts of services in the future.
Just on north Wales, one of the things that was very striking when we were receiving evidence was the evidence just about the lack of access to these psychological therapies. We've all received an e-mail from Dwynwen Myers, who is one of the perinatal clinical psychologists in north Wales, and she's made it quite clear that she has 18.5 hours per week to cover the whole of north Wales in terms of the perinatal mental health in that region. Much of thattime is spent travelling from one place to the next. She gave an example of spending three hours in the car in a six-and-a-quarter-hour day. Thatis unacceptable. We can't have a situationwhere people who need access to psychological therapy are simply not getting it. We know that when we nip problems in the bud, sometimes it can resolve things in a way that takes the sting off further down the road. So, I absolutely support the need to spend to save in this particular area in order that we can get things right going forward.
I do want to pay tribute as well, as the Chair did, to the voluntary sector and for the work that they're doing. We had some very moving testimony from women who had been in very difficult situations, some of them at the point of wanting to take their own lives at times, who had searched and scoured their local areas looking for support and had suddenly stumbled upon, very often, local groups, help groups, peer support groups. I think we cannot underestimate their value. I, for one, would very much like to see a mapping of those services across Wales and some seed funding to help them grow and to improve the quality of what they do. If there's one thing that I think would make a significant difference to those organisations, it's just that little bit of seed funding in order for them to grow the support networks that they're able to provide.
So, I congratulate the Chair on the excellent inquiry, and whilst I'm pleased very much with the Government's response, I do think that there are some areas that are wanting in that response, and I look forward to hearing the rest of the debate.

Llyr Gruffydd AC: I'll start by echoing the thanks to the Chair and fellow members of the committee, to the clerks, officials and to the stakeholders, who have played a very dynamic role in this debate—more so in this case, I think,than in any other inquiry that I've been involved with. I have to say also that this is one of the most heart-rending inquiries that I have been part of in my time here in the Assembly. Hearing the stories of some of the mothers who were suffering perinatal mental health issues was heartbreaking at times, and hearing those when they were most vulnerable: that they had to decide to leave their children behind to actually access the services that they needed to recover. I can't imagine anything that could make the condition worse than making such a decision under those circumstances. But I do take some comfort, if I may say so, in hoping that this will be one of the most successful inquiries we've held in terms of delivering some of the recommendations made by the committee. I won't talk to soon, but I do think that there are some positive signs in terms of some of the main recommendations made.
Clearly, the first recommendation of establishing a clinical network has been accepted by the Government, and that's something that I warmly welcome. I look forward now to hearing from the Minister about the work that's happened on that front in terms of establishing the managed clinical network and the work of the recruiting a lead role that was supposed to happen during this financial year. So, I would want to hear what progress has already been made on that first recommendation.
Another clear call by the inquiry, as we've already heard, was that for an in-patient unit for mothers and babies. Since the closure of the Cardiff unit in 2013, there has been some debate on the need to re-establish that service. There is a clear recommendation on where that unit should be, but also there is a clear message on the need to provide services in north Wales. As a Member representing the North Wales region, you wouldn'texpect me to argue any different case. There are opportunities here—and there are opportunities that we have referred to in other contexts—to develop cross-border services, which don't necessarily mean one-way traffic from people who need a service having to travel to the west of England. There is an opportunity here to turn that around in negotiation with the health service in England to establish a centre in the north-east of Wales, which could then serve a wider catchment area. So, that is something—as the report recommends—that needs to be subject to urgent debate, and I would hope that the Government would pursue that issue.
Of course, along with this inquiry, there was an agreement between Plaid Cymru and the Government, which ensured a commitment to providing specialist provision for in-patient perinatal mental health, and I'd be eager to hear an update in terms of delivering that. I know of the work that WHSSC has been doing in considering the options, and I'd be grateful to hear where we are on that, because time is of the essence in this context. I'm certainly pleased with the role that my party played in ensuring that this servicewill become a reality in future, hopefully in the near future if possible. Also, the other element in the agreement between Plaid Cymru and the Government was to secure £20 million of additional investment annually in broader mental health services. There is no doubt that elements of that will contribute to much of the ambition in this report, particularly, as the Minister has recognised in responding to the recommendation, in tackling the variation in services between the various health boards in Wales. We heard the term 'postcode lottery', as is heard in so many other contexts, but certainly we now do need to tackle that issue.
Broader workforce training is important, of course—the emphasis we heard from the Chair on investment in preventative factors; that is, investing to save. We heard the figures quoted, not only the cost to the health service, but to wider society. Upfront investment is a way of saving money, and it's not just a matter of saving money, but saving individuals from the anguish and angst that they face where much of this could have been resolved far sooner.
I see that time is against me so I will conclude by referring to the other element, another important factor that is recognised, and that's stigma, which is common to all sorts of mental health problems. I will take this opportunity to remind fellow Members that today is Time to Talk Day, to put an end to mental health stigma. It's very timely, in my view, that we're discussing this today, and I would encourage all Members, as I will do, to take the opportunity to have that conversation with people. It's quite right that we discuss mental health issues, but it's also a duty on us all to do everything we can to tackle all aspects of those conditions, starting with delivering the recommendations of this report.

Jenny Rathbone AC: Llyr just stole my line. Of course, it's great timing: we are talking about this report on the eve, I think, of Time to Talk Day, becauseobviously you produced your report in October and then the Government responded in November. So, well done to the leader of the house that she timetabled this discussion for today.
Having a baby is a messy business. One minute you're a booted, suited woman with a job to go to, and the next minute you're a sleep-deprived milk machine entirely dependent on other people to enable you to begin the lifelong journey of motherhood. And that's assuming you have those support mechanisms, because if you don't, or the support is given to you conditionally or grudgingly or resentfully, the journey is much more challenging.
So, I think this is a really important subject. I think nobody's mentioned so far that you are, of course, at increased risk of domestic violence if you are pregnant. Those who've been previously abused are four times more likely to be abused during pregnancy than women with no history of violence. Other risk factors of single mothersare lower education, lower socioeconomic status, alcohol abuse and unintended pregnancy. Perinatal mental illness—there's a strong association with domestic violence, both perinatally and during your whole lifetime. They're not necessarily always present. You can obviously have postnatal depression without having an abusive partner. The reasons you've got your depression can be completely unrelated to anything like that. But we have to be aware that there are these risks, and that mothers are really, really vulnerable when they first have a baby.
So, I think your recommendation19, continuity of care from a midwife or a health visitor, is absolutely essential. In my day, you had up to 10 days of visiting at home, unless you agreed collectively that you didn't need it because you had good support mechanisms. But these days I know it's not that consistent, and parenting doesn't come with instructions. Mothers desperately need independent professional advice without the emotional baggage you often get from other family members.
Recommendation 16 feels a bit like groundhog day to me. I'm pleased to hear that Llyr thinks that this is going to be a ground-breaking report, and that we're really, really going to change things, but I can remember discussing this, I'm afraid, a very long time ago.The Edinburgh postnatal depression scale has been aroundfor at least 30 years and it's a really, really simple tool for asking women how they're feeling, which enables you to assess the potential risk; obviously, not losing sight of your ability to observe the woman and ensure that you've understood—. You already know the person, so you're able to also observe whether or not you think there may be depression going on.
But I find it really depressing that we're still talking about the need for midwives and health visitors and GPs and any other health professional who comes into touch with postnatal women to have these skills, and also to actuallyask the question, becauseit is completely essential for safeguarding of the mother and the child that we are asking these questions. Lynne Neagle asked if we can afford not to provide these services, and the answer is that we absolutelycannot affordnot to, becauseof not just the impact on the mother but the impact on the baby. The baby starts communicating the minute it's out of the womb, and, if the mother, who's the main person that the baby's in touch with, is not communicating with the baby, the impact is absolutely devastating. Why wouldthe baby bother to communicate if they're getting no response from the adult? If the adult is utterly depressed, they won't be responding.
So, it's completely essential that we have professionals involved, as well as family members, to ensure that, if the personis perinatally depressed, there are other people around to talk to the baby, becausethe consequences otherwise are lifelong: the failure to secure attachments, the impact on the infant's social, emotional, cognitive and language development, facilitating development of good mental health in childhood and adulthood—as you heard in your evidence.
I'd be very interestedto hear from the Cabinet Secretary about the familyresilience assessment tool as a way of complementingthe Edinburgh postnatal depression scale, becausewe absolutelyhave to ensure that the inversecare law doesn't apply here and that those who most need the services of professionals are getting them. One in five women—that means everybody needs this service and everybodyneeds to understand that we need to talk to women about their perinatal mentalhealth.

Michelle Brown AC: First of all, I'd like to pay tribute to the women and families with lived experience of perinatal mental health challenges who gave the committee the benefit of their hard-won experience during the inquiry. I was horrified by the stories from women and families, who I cannot help feeling have in some cases been grossly let down—but not by the health professionals who are striving to help women in a health system that clearly needs considerable improvement. Ithink it's a testament to the tenacity and commitment of health professionals and charities that women are still receiving services despite the difficult circumstances.
The most shocking thing for me was that, despite the significant number of womenin Wales who may need in-patient care, there is no in-patient care facility in Wales and there hasn't been any since 2013 when Wales's one and only MBU shut. Since then, the committee estimates that up to 100 women a year have either had to take up in-patient care in England, as far as London or Nottingham, or been treated in an adult unit and separatedfrom their baby. The Royal College of Midwives note that the numbers of women admitted to in-patient care given by the WHSSC would suggest that between 45 and 65 women needing in-patient care are not receiving it. That's an awful lot of women who are missing out on the relevant care. It's a most glaring deficiency to me.
As pointed out in the report, NICE guidelines state that women shouldideally be in a mother and baby unit, unless there are compelling reasons for her not to be there. These compelling reasons aren't existing at the moment. The fact that we don't have one—that's not a compelling reason for a woman. Why don't we have one? The reasons for closing Wales's one and only MBU, according to the evidence provided, were: insufficient funding, misunderstanding about who could access the unit,the unit being too small to develop the necessary specialisms and less interest in, or acknowledgement of, perinatal health issues at the time. To me, none of these reasons justified the closure of the unit. The solution to keeping the previous MBU open was in the hands of the local health board and the Welsh Government. In my opinion, they let a lot of women and their families down by closing that unit.
The report refers to a lack of information being provided to women about the benefits of a mother and baby unit, but I would suggest that uptake of in-patient care would inevitably be better if barriers, such as distance or separation from their child, were not there in the first place. As well, I'd suggest that it's pretty pointless advising women about the benefits of in-patient care or a mother and baby unit when the right care is not going to be available to them.
I am, therefore, pleased to note that the Cabinet Secretary has accepted the committee's recommendation that an MBU be restored in south Wales. Whilst I'm pleased that the Cabinet Secretary is developing those plans, it won't be accessible for women and families in north Wales. The report acknowledges that north Wales doesn't have a sufficiently high birth rate to make a north Wales MBU viable, as does the Cabinet Secretary. I note that the Cabinet Secretary has asked the Welsh Health Specialised Services Committee to discuss the options for north Wales, but his detailed response falls short of an undertaking to establish an MBU in north Wales that is accessible to people in north Wales and mid Wales, whether shared with England or not. It appears to be simply a promise to think about it.
Personally, I believe that the proposal for an MBU in north-east Wales, to be shared with England, is an excellent one. The present situation, whereby Wales relies on in-patient beds in England, is untenable. South Wales may get an MBU, but people in most parts of the rest of Wales will still have to rely on Wales's ability to commission beds in England. The WHSSC stated that obtaining an MBU bed is becoming increasingly difficult. This leaves Wales, especially until we have our own MBU, at the mercy of decisions made by NHS England and the demands on those services in England.
The report refers to a hidden demand for perinatal care, and I would like to see the Welsh Government properly address the call by the committee for the Welsh Government to identify the level of demand for an MBU in Wales. I would therefore ask the Cabinet Secretary to provide details about how the level of demand for an MBU across Wales is going to be assessed.
Another point I'd like to speak about is continuity of care. A recurrent theme was that the women needed continuity of care, and we heard that women seldom, if ever, have this. One of the challenges identified during our inquiry was the under-reporting of perinatal mental health problems by women themselves. But, without continuity of care and the ability to form a relationship of trust with a health professional, how is a woman and her family able to feel confident to voice any concerns to those people about how that woman or her familymight be feeling? The health professionals themselves have no reference point to assess mothers and offer assistance.
So, the systematic and continued failure of Welsh and UK Governments to invest in training for the relevant professionals has produced this situation. We have failed to train our own staff and now find ourselves being unable to recruit professionals for our own health service. This is denying women the continuity of care and a relationship of trust with a regular health professional with whom they feel safe enough to discuss their mental health.
Regardless of all of that, I am, however, encouraged by the Cabinet Secretary's initial response to the report. I look forward to hearing an update in due course on your progress in implementing the report's recommendations, in particular, recommendation 7 relating to the creation of an MBU in north Wales shared with England. Thank you.

Mark Reckless AC: I agree with Michelle Brown that one of the perplexing elements—at least as I found it—about the inquiry was trying to understand why the mother and baby unit that had been operational at the Heath hospital in Cardiff until 2013 closed. I don't feel we quite got to the bottom, at least to my satisfaction, of what the thinking was and what the justification was for why that happened at the time.
It certainly seemed that it wasn't being sufficiently well promoted across the health system in Wales. We found evidence from north Wales of people who actually came, in the end, to that unit and it turned around the situation for them. They were signposted to it informally by people outside the Government and health board-provided system.
It's not ideal for people in north Wales that there aren't enough people there to justify a unit just for north Wales. Perhaps an arrangement could be made with Manchester,perhaps with people from Manchester coming to north Wales for a change or whether people from north Wales do on occasion travel to Cardiff or somewhere else in south Wales—the Royal Gwent Hospital have done a bid within my region and I know there's been a lot of consideration of different specialist services and where they should be going. Despite the excellence of the Heath in Cardiff, I know there are many other hospitals that can ably do this.
I believe the Cabinet Secretary accepts our recommendations 3 and 6. He referred to, and I had to check the acronym here:
'The Tier 4 sub-group of the AWPMHSG is currently costing options for consideration, whileconsidering the concerns raised by WHSSC’s Joint Committee. The options are to be presented to the Joint Committee in January.'
Given that it's 31 January today, I hope the Cabinet Secretary can report to us as to what the joint committee made of those recommendations. I'd just like to emphasise, I think for the committee as a whole, that what we felt was important was that there should be a mother and baby unit. We believe, as I think the Cabinet Secretary does as well, that there is sufficient demand in south Wales to justify one. Given the fixed costs and the necessity of specialist care at that mother and baby unit, it strikes me that that has to be a full mother and baby unit as opposed to a different model of provision that's more localised. I just can't see how that operates on an in-patient basis with specialist perinatal services for mothers, because the demand just isn't sufficient to justify several centres with the level of specialism necessary. So, I hope the Cabinet Secretary will update us on that.
Following on from Jenny Rathbone's remarks, if I understood correctly, I think the reference was to a fifth of mothers needing some potential engagement with mental health services at this stage, and I think you then referred to that being everyone, which I didn't quite follow through on, but it's clearly a substantial number. I think, when you're looking at a pathway or thinking of how the care operates in this area, there are some different categories. There are women who have been in contact with mental health services or have issues perhaps with active treatment at the time they fall pregnant and then give birth—. I give way, Jenny.

Jenny Rathbone AC: Just to clarify, really what I meant to say was that, because it's one in five, everybody needs to be screened. Because the prevalence is so high, we're unable to say this is just a small minority.

Mark Reckless AC: I would agree with you on that, and I think the circumstances of birth and the way the health system supports it do allow that. Our baby's now eight months old, but when my wife gave birth in May last year, we were very struck by the quality of the provision and just how much we had in the way of midwife visits and how many interactions we had prior to being discharged from that service. While that level of attention is being given, it is an opportunity to explore these issues to screen. It's sometimes quite difficult to make a binary diagnosis of whether someone is suffering from postnatal depression, for instance, or not, but there are some pointers or suggestions that that is a risk or perhaps that they may be. And I think that, in those circumstances, having a step down and step up to the system, potentially involving the third sector, is very important. So, in some cases, where a baby is discharged but there is thought to be the basis for follow-up, sometimes that will be done through the health visitor but, potentially, also through the third sector, and just flagging circumstances where it's worth that extra bit of follow-up to see if you can catch people. So, you have a group who already are in contact and those who are not.
And then there are the really quite serious things. I was quite struck by postpartum psychosis, and I'd particularly like to give credit to Sally Wilson, who I thought was a fantastic witness who really assisted me in understanding this issue. Simply the extent to which patients can respond to someone from the third sector who's been through that experience themselves is so important, I feel that we need to do more for our health systems to integrate that third sector unique support to give women the support they deserve and need in these circumstances.

Thank you. Julie Morgan.

Julie Morgan AC: Thank you very much, Deputy Presiding Officer, for calling me to speak in this very important debate. The Chair and other speakers have outlined the extent of the problem and how it affects the baby as well as the mother and other children in the family.
The issue about the mother and baby unit has been very clearly made. I think everybody agrees. All the speakerswho've said anything this afternoon have made the case for having a specialist mother and baby unit, and I'm pleased thatthe Government has responded well to that. Because we did hear very distressing stories about how the absence of a local mother and baby unit made it very difficult for women who needed in-patient care and actually did have an awful choice of having to go to either adult psychiatric care wards without their baby, or going to a mother and baby unit in England, often very far away.
We did hear from one third sector volunteer who needed help, but her nearest mother and baby unit was Manchester, and she turned it down because of the distance she'd have to travel, which would involve her being away from her family support network. But looking back, she knew that that would've been the best for her mental health. Certainly, what I've felt from this inquiry is the big benefits thatcan come from in-patient treatment, which I don't think I was aware of before we actually did this inquiry. So, it was awful to think of people missing out on it.
It was disappointing that the mother and baby unit closed in Cardiff in 2013. I was involved, some years before that, in helpingto keep it open, but, basically, I think the beds were underused, but that's perhaps because there wasn't a proper understanding of what the beds were needed for. In any case, the clear message from our committee is that there should be a mother and baby unit along the M4 corridor, and that arrangements should be made in north Wales. I think that that is one of our strongest recommendations.
Secondly, I just wanted to refer brieflyto the issue that came up about breast feeding. We all know how important breast feeding is to the health of children, but it's also very important to the mother and child bonding process, which, in turn, of course, does help the mental health of the mother. And I am concerned about some of the evidence that we had, which did seem to show that mothers who failed to breast feed and felt they were failures were moreat risk of perinatal mental health problems. So, I think that's something that we should be aware of, because I believe we must be doing all we possibly can, as a Government, to promote breast feeding, but, obviously, we did get evidence that, on times, it was very difficult for women and that this can make them more vulnerable. So, I thought that that was a very important point thatcame up.

Hefin David AC: I'd like to just add, as a member of the committee, my support to that view, and note that, although the recommendation has been rejected on that count, the Government has undertaken a work stream and perhaps what we need to do is get further understanding of the impact of the difficulties of breast feeding on perinatal mental health.

Julie Morgan AC: Yes. Thank you for that intervention. I think that's definitely something we should look at.
I wanted to end, again, echoing the themes that have come up this afternoon about the importance of the third sector and those voluntary groups we met, which, I think, were absolutely outstanding, like what's now called Perinatal Mental Health Cymru but which used to be called Recovery Mummy. It was set up by a constituent of mine, Charlotte Harding, and I know that the Cabinet Secretary has visited the Llandaff North hub where she operates. She set up the group in response to thelack of services available, and she herself has lived through postpartum psychosis, perinatal anxiety and depression. She has suffered and recovered from alcoholism, self-harm, agoraphobiaand had an eight-year battle with eating disorders, and she openly talks about these huge difficulties that she's been through. And now, her organisation is offering a new mums friendship support group, mindfulness sessions, postnatal exercises and also one-to-one support for new dads.
She gave evidence to the committee about what a huge demand there is for her services. GPs are sending people to her, and yet this is a voluntary group, operating with absolutely no money. I think that is one of the biggest issues for me—that people in her position are in the best position to give that individual support to other people, other mothers, but they do need funding to do it. So, I would end, really, with a plea that these unique groups like Recovery Mummy, those are the groups that I think we need to put additional support into and to make them, essentially, a real part of the whole service.

Caroline Jones AC: I would like to thank the Children, YoungPeople and Education Committee, along with the Chair, for their work on this inquiry and for the report.
Perinatal mental health problemsare very common, affecting around20 per cent of women at some point during the perinatal period. They're also a major public health issue, not just because of their adverse impact on the mother, but also because they have been shown to compromise the healthy emotional, cognitive and even physical development of the child, with serious long-term consequences. A study by the Centre for Mental Health found that, taken together, perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK. This is equivalent to a cost of just under £10,000 for every single birth in the country. Nearly three quarters of this cost relates to adverse impacts on the child rather than the mother. Research undertaken by the London School of Economics in 2014 found that 70 per cent of Welsh mothers did not have access to specialist perinatal mental health services, and Wales's only in-patient mother and baby unit closed in 2013.
As the committee's report highlights, the Welsh Government have invested in perinatal mental health services. The recent injection of £1.5 million has improved access to specialist community perinatal mental health services, but as the committee discovered, there is an unacceptable variation in service provision across Wales. Mothers have a right to such services, and access should not be determined by the postcode. I welcome the committee's recommendations to establish a clinician-led managed clinical network, which will provide the necessary national leadership together with the expertise needed to develop both the perinatal mental health service and the workforce. This is essential if we are to provide a first-class service in every community in Wales.
I also greatly welcome the committee's recommendation to establish a mother and baby unit in south Wales. NICE guidelines recommend the use of a mother and baby unit for in-patient treatment of new mothers. Since the closure of the Cardiff mother and baby unit in 2013 the care for mothers with severe mental health problems has been woefully inadequate, according to the British Psychological Society. The mother and baby unit closed not because there was no need for it; it closed because it was mismanaged. Insufficient funding and mismanagement of beds were some of the reasons disclosed to the committee. It is therefore imperative that we have a unit in south Wales.
I greatly welcome both the committee's recommendations on this and the fact that the Cabinet Secretary has accepted those recommendations. I look forward to an update on progress shortly. This is too important an issue to drag on for months and years.
I would like to once again thank the committee and the Chair for their excellent work on this report, and welcome the fact that the Welsh Government have accepted the majority of the recommendations. We now look forward to rapid progress being made as this year we will see between 3,000 and 7,000 new mothers suffering with a perinatal mental health issue, and without swift and proper treatment, the mother and child will suffer the effects for years to come. Thank you. Diolch.

Thank you. Can I now call the Cabinet Secretary for Health and Social Services, Vaughan Gething?

Vaughan Gething AC: Thank you, Deputy Presiding Officer. I'd like to thank committee members for their work in producing the report on perinatal mental health, and the Chair for the way in which she opened today's debate. I do welcome today's debate, which reflects how far we have come in recognising perinatal mental health issues. The days when mental health issues in pregnancy and postnatally were dismissed as simply common complaints that would disappear over time are thankfully in the past. There is an increased awareness and recognition that must lead to much improved care to enable us to tackle issues that can have a severe impact on families, as has been set out in today's debate, especially when people can feel at their most vulnerable.
I'm pleased to agree in principle 23 out of 27 recommendations in the report, and I'll summarise some of the action that we're taking that arises from the inquiry. Members will be aware that steps have been taken in recent years to improve prevention and early intervention. So, the all-Wales maternity record, the Healthy Child Wales programme and the new family resilience tool that Jenny Rathbone mentioned are helping to identify early on the additional mental health support new mothers may need. On that particular point, the family resilience tool has been developedwith support from the Government, with leadership and with finance, and since October last year all health visitors in Wales are being trained in its use. So, we are looking at—[Inaudible.]—to improve practice and to help families with the greatest need.

Vaughan Gething AC: And, of course, the £1.5 million a year of additional investment we've made, putting it into building community services in every health board, has been instrumental in providing support as close to home as possible for more families right across Wales. In some areas, that's led to new communityservices that are still in their infancy, while others have been able to use the additional funding to expand an existing service.
What is important is that we have both the commitment and the mechanism in place to ensure consistent standards of care across Wales. I therefore welcome the committee's recommendation that we establish a managed clinical network for perinatal mental health here in Wales. That network will be led by a lead clinician to help drive forward improvements, including implementing clinical standards nationally and data collection. It will provide for a more formal governance and accountability, and that work will build on the excellent work done by the all-Wales perinatal mental health steering group. And I'd like to thank those people for their continued commitment to improving access to people who have perinatal mental health problems. The Welsh Government will provide funding for the new network, and meetings have begun between both the Government and the national health service to put this in place from the next financial year.
The committee report also refers to the need to develop standards and outcomes. And a point made by the Chair and others was that draft guidance for an integrated standards framework for Wales was presented to the all-Wales steering group last week. The pathway and standards will support the delivery of more consistent outcomes for women and their families wherever they are in Wales. That work is continuing to make progress.
And on training and continued professional development, the steering group is developing a learning and development framework for staff here in Wales. We expect that to be published later this year. The new clinical network will also monitor and identify further training for midwives, health visitors, GPs and other health professionals. And I will also expect that new network to consider how current provision meets the Welsh language needs of the population.
The committee is, of course, aware of our commitment to provide specialist in-patient care in south Wales. I'm happy to confirm that at the Welsh Health Specialised Services Joint Committee on Monday, health board chief executives supported the need for a mother and baby facility and asked to be provided with detailed business cases in May of this year. Now, that could an adaptation of an existing building on the NHS estate as an interim measure before longer term options are considered. We will still need to consider how to make sure that a new unit is properly and fully used, because wherever it is located within the south Wales corridor, there'll be a number of women for whom that will actually be quite a long distance. So, we need to think about not just the mother and baby unit as the answer, but as part of the answer in addition to improving our community-based services.
And I'm pleased that the committee have recognised that whilst there is a case for in-patient provision in south Wales, we can't say that provision in south Wales would also cover the north as well. So, it's been recognised again that there are insufficient numbers within north Wales to sustain a safe in-patient service for north Wales alone. I recognise what the Chair had to say on this point, and I gently say to Members that, for some of the comments that have been made, we're not in a position to compel NHS bodies in England to utilise a north-east Wales facility. There is, however, an ongoing conversation about what we could do working alongside partners in the north-west of England.
And, in fact, the Welsh Health Specialised Services Committee has been working with Betsi Cadwaladr University Local Health Board to explore options just for that—for in-patient care for north Wales residents.I will expect WHSSC and health boards to work together to agree a model for in-patient care at greater pace over the coming months. To give an understanding of the current expenditure: the current cost of placements is forecast to be around £0.5 million this year, and that could be better deployed towards providing services here in Wales.We are, of course, providing an additional £40 million over the next two years towards mental health services, which health boards will use to enhance services in line with the 'Together for Mental Health' delivery plan.
To touch on some of the recommendations that weren't accepted where there is work already ongoing—on breastfeeding, which was mentioned in today's debate, there is a task and finish group that I was pleased to hear mentioned in the contributions from Julie Morgan and Hefin David, and that is looking at breastfeeding practice across Wales.That's due to report in March. It is importantthat it isn't just an issue for perinatal mental health. There are a number of reasons why we want tobetter understand how much we currently support women and partners to breastfeed, and the broader environment in society at large, so that women are supported to be able to breastfeed in public in a range of settings. We're all far too familiar with ongoing incidents where people are simply intolerant and expect women to move aside or to be put away from public. I think that is the wrong view. I think, actually, we need to adhere more—. I call for honesty and grown-up measures on a range of health services, and this is absolutely one of them. The whole public needs to be engaged, and it's an entirely natural thing to do, and we need to support women and others to do so. Regarding medication, of course, breastfeeding mothers and pregnant women who require medication should be individually assessed, with a joint plan of care put in place. And it is for those women and their healthcare professionals to make appropriate choices around medication and understand the risks in either providing medication or not doing so.
On the role of health visitors, health boards have put multidiscipline community services in place. And perinatal mental health services have worked with the generic midwifery and health visiting service to raise awarenessof the perinatal mental health referral process to try and deliver greater seamless provision postnatally. And as the Chair recognised at the outset, this is a not uncommon feature pre or postnatal, and it is part of what the generic service should be able to deliver and recognise. We will continue to be led by evidence and professional advice about the skill mix of staff that we require to deliver the service that people in Wales require. And it was positive to hear Mark Reckless's comments about his own experience where his family had had a birth here in Wales and the level of servicethat they received. And we shouldn't lose sight of that. We actually have a lot to be proud of with our midwifery and health visiting teams here in Wales, partly because there is a real thirst within the profession to learn and to improve, and it's a particular feature of our service here in Wales.
I can see I'm coming towards the time, Deputy Presiding Officer, so I just want to recognise in the final point that the next major milestone will be the publication of the research project into perinatal mental health services in Wales, by the NSPCC, Mind Cymru and the National Centre for Mental Health. That's due to be completed shortly. I look forward to reading its findings, which should give us a clearer picture on how perinatal mental health services here in Wales are currently meeting the needs of families, and also what more we need to do to better understand and meet those needs.

Thank you. I call on Lynne Neagle, as Chair, to reply to the debate.

Lynne Neagle AC: Thank you, Deputy Presiding Officer. I'm going to have to be very quick because I haven't got a lot of time, so I won't be able to respond to everybody's points, but thank you to everyone who's contributed, and it's great to see such a range of speakers across the Chamber on this very importantsubject. I'll just try and pick up on some of the points from the debate.
Darren Millar referred to the importance of psychological treatments, and that is absolutely key. We had verypowerful evidence in that area. And I think it is very importantthat we remember that the issues that we dealt with around medication could be alleviated by access to psychological therapies because, often, it's medication that is put into the void. Darren also talked about the importance of needing to map services, and the Cabinet Secretary in his response referred to the work that's being undertaken, the research on that, and I think that will be a very useful piece of work going forward that I hope that the committee will be able to return to.
Llyr reminded us of the timeliness of this debate and the fact that it's Time to Talk Day tomorrow and the issues around stigma that we dealt with, as with Jenny. Stigma was a very clear theme in this inquiry and I think it's importantto remember that stigma is a particular issue for women having perinatal mental illness because they are very fearful that they may in a position where they might have the child taken away from them. So, it is absolutely crucial that we tackle those issues around stigma. That was also pickedup by Jenny, who also raised the issues around continuity of care, which Michelle also spoke about—again, another very consistent theme in the inquiry. Women are fed up of having to tell the same story to lots of different professionals. It is really important, notwithstanding the constraints that there are around the workforce, that we seek to get that continuity of relationship there, both with midwives and with health visitors.
Both Mark and Julie referred to the importance of the third sector. And that was, as Julie said, a really powerful piece of evidence, really—that we have these organisations that literally are running based on carrier-bag collections in supermarkets, yet they're having referrals from social services and from GPs, and that simply has to stop. We have to have a system where health boards and other bodies recognise the role that they play and fund them accordingly.
Caroline Jones, in common with a number of Members, added her support for the establishmentof mother and baby unit provision in Wales. It is absolutelykey and I think that we have to remember that, in addition to obviously being a very difficult time for women, perinatal mental illness is actuallya leading cause of maternal death. The consequences of not getting that care right can be very serious indeed. So, we do need to invest in this provision and get it right.
So, can I just close by thanking again everybody who contributed to the debate, including the Cabinet Secretary, all theMembers of the committee for their hard work on this inquiry, the committee team who, as always, have been fantastic, and everybody who engaged with us on this important piece of work? We will be revisiting this on a regular basis and monitoring the implementation of this report going forward. Thank you very much.

Thank you. The proposal is to note the committee's report. Does any Member object? No. Therefore, in accordance with Standing Order 12.36, the motion is agreed.

Motion agreed in accordance with Standing Order 12.36.

I now propose to go to voting time. Unless three Members wish for the bell to be rung, I am going to proceed to call the vote. Okay.

8. Voting Time

We now move to votes on the Member debate under Standing Order 11.21 on leasehold, and I call for a vote on the motion tabled in the name of Mick Antoniw, David Melding, David Rees and Siân Gwenllian. Open the vote. Close the vote. For the motion 34, 14 abstentions, one against. Therefore, the motion is agreed.

NDM6626 - Member Debate under Standing Order 11.21(iv): For: 34, Against: 1, Abstain: 14
Motion has been agreedClick to see vote results

9. Short Debate: Getting in there: Scores on the doors for disability access and defibrillators

I now move to the short debate. If you're leaving the Chamber, can you do so quickly, please? So, we now move to the short debate and I call on Suzy Davies to speak on the topic she has chosen. Suzy.

Suzy Davies AC: Diolch, Dirprwy Lywydd. Thank you, Cabinet Secretary, for responding to this today. I’ve tabled this particular debate as a step in what I hope will be a successful campaign. It’s a chance for Members to begin considering whether what I’m about to talk about would be a useful, practical and reasonable step towards equality in their constituencies and regions, and it’s a chance for you, Cabinet Secretary, to expand upon the Government’s initial observation that:
'In principle, this idea seems to have some merit and we would be interested to see how the practicalities of such a scheme would work'.
In November, the Bridgend Coalition of Disabled People opened an e-petition via the Assembly website, which in due course will of course be considered by the Petitions Committee. I hope that this debate and your reply, Cabinet Secretary, will be of use to the committee in those considerations, and I urge all those Members who I hope are watching this from their offices to tell your constituents about this as it will be open for signatures until March. It’s already got over 1,700 signed-up supporters, but I’d really love it if we could get enough so that we can have a full Plenary debate on it.
The Bridgend Coalition of Disabled People is a very active and well-regarded campaigning organisation in my region, with some executive members also sitting in other national bodies representing people with disabilities. You will probably already know some of them from their engagement work with Assembly Members and of course Government.
The coalition is calling for the Welsh Government to bring in an access certificate, showing numbers from zero to five, along the lines of the food hygiene certificate. All buildings used by the public—such as shops, food outlets, sports clubs, pubs and offices, as well as public transport services—should be assessed on how wheelchair accessible they are, as well as how easy it is for someone with a sensory impairment or learning disability to use.
I think this fits very well with the debate we had a little bit earlier today on some of those scores. Its members would also like premises to be given a number, which they could then display to show how disabled friendly their premises are.They argue that those who achieve high ratings could possibly persuade others nearby to improve access and get a higher rating themselves. They cite the obvious comparison here, which is the food hygiene certificate, as a success, saying that since the mandatory introduction of the food hygiene certificate, food standards have vastly improved and premises with a high number use the certificate with pride.Coalition members believe that businesses will make a big effort to improve access and services for the disabled community if a similar certificate were introduced for access, leading to hugely improved services for disabled shoppers and those who want to go for a drink, a meal or to use public transport—the facilities that most of us take for granted. It's a win-win situation: better services mean more customers.

Suzy Davies AC: The petitioners have given an indication of what information the scores should be able to convey. I have some ideas to add to that, which I’ll come to in a few moments, but they suggest that to achieve a 5 rating, a premises will not just need to be wheelchair accessible, but be fully inclusive for those with visual and hearing impairments, and staff understanding of those with learning impairments. Having a restaurant with Braille menus or staff able to use sign language can make a huge difference and give someone a far easier and less stressful experience when doing everyday things that most will take for granted.
Another idea they put forward, as well as having a 5 to 0 rating, is to have extra symbols beneath to show whether a premises has full wheelchair access, an accessible toilet, information in Braille, staff who can use sign language and whether the premises is—to quote the petition—'autism friendly'.
I don’t really want to get caught up in the specifics at this stage. It would be just too easy to dismiss both the petition and the idea because of vague terms like 'autism friendly' or 'disabled friendly'. I know that it would be impossible to anticipate, for example, the individual response and, therefore, the access need of every single person with an autistic spectrum condition. Myself, I’d say that the minimum requirement to get a score on that would be that key members of staff would have had awareness training, but that’s what consultation is for and we are not exactly short of individuals and bodies to consult here in Wales.
Some of them have already offered their support for the coalition’s proposals. The National Autistic Society Cymru, for example, have said:
‘For hidden disabilities such as autism, access to goods and services can often be about making changes to the physical environment but having an awareness of different conditions is also key. NAS Cymru would welcome disability awareness training, including autism, for staff who interact with the public so that autistic people don’t feel socially isolated and unable to access shops and services.’
Guide Dogs Cymru, in their report, 'Access to food premises for guide dog owners and other blind and partially sighted people', lays bare the problems experienced by some of Wales’s 100,000 people with sight loss. Taxis, restaurants, newsagents and convenience stores, cafes and high-street shops are the five most frequent places to refuse access to guide-dog owners, although, conversely, restaurants and high-street shops also have the best service when it is offered. I think that demonstrates that the missing ingredient for some businesses is thinking about accessibility in the first place.
Guide Dogs Cymru says:
'For blind and partially sighted people, the petition would help in two ways. Firstly, it would raise awareness of the importance of access to buildings. Accessible buildings increase the opportunity for blind and partially sighted people, and all people who are disabled, to live independently in the community. Poor access to a building is a major factor in deciding whether it is possible to use a leisure centre, library, restaurant or doctor’s surgery without help. Secondly, by raising awareness of the importance of access to buildings, there is a good chance that improved knowledge of this topic on the part of service providers would lead to reductions in the number of access refusals.'
Before I go on to the practicalities, I just want to mention those three other ideas that I've got that I think can be accommodated in this. First of all is a scoring or information system to demonstrate dementia awareness within a business. If we’re serious about dementia-friendly communities, let’s include this. Secondly, communication difficulties—we heard yesterday from David Melding that Afasic Cymru will be closing its offices in Wales, but that doesn’t mean that this is a closed matter. Thirdly—well, probably no surprise here—emergency life-saving skills and defibrillators. Members may remember their support for my legislative proposals to help create a nation of lifesavers in the last year of the current Assembly. Among those were proposals to increase the public availability of defibrillators and to increase the take-up of emergency life-saving skills by staff who work in publicly accessible buildings, so that members of the public could benefit from their expertise, not just the workforce in that building.

Suzy Davies AC: Now, for those practicalities.The first point to make is that there are sporadic examples of this idea in practice already, thanks to organisations like NAS Cymru and the Alzheimer's Society. Brecon is a dementia-friendly town, Milford Haven is an autism-friendly town, both titles being predicated primarily on awareness training. Some of our major stores and theatres have introduced quiet or relaxed shopping periods and performances to help people and their carers, as well as staff, feel more comfortable sharing these everyday experiences and they'll have signs or certificates to show that as well.
Mark Isherwood told me, a few days ago, about Communicating With Confidence, which is a small charity in north-east Wales, which raises awareness of the communication difficulties of people of all ages and walks of life as a result of stroke, Parkinson’s, MND and brain injuries. They want a national communication symbol to add alongside those familiar badges for hearing, visual and physical impairment, and already use signs and stickers locally to promote awareness.
And as for defibrillators, well, I’m sure you all have seen the lightning mark appearing in more public places now, but it is hardly universal coverage. We are still in a position where the key information on where your nearest defibrillator is can only be discovered by phoning the ambulance service, using up valuable time. The head of the British Heart Foundation this week declared his support for extending the principles in this petition, saying,
'Ensuring the public know where they can access a defibrillator or help from a CPR trained individual is vital to saving lives.'
What this shows, I think, Cabinet Secretary, is that all of us, not just people with disabilities, respond to recognisable symbols where those symbols are consistent and widespread. While I imagine we’re talking consultation again on what any new symbols might look like, the cost of adding a few more symbols to the existing sticker collection, websites or written material is hardly likely to be exorbitant.
Who should be responsible for training? Well, it's clear to me that training should be carried out by people who know what they’re doing, including people with disabilities themselves, absolutely on co-productive principles. I don’t think it’s beyond the sector to be responsible for the strategy and planning either, but this is an open question as far as I’m concerned. I can foresee, for example, that this is likely to affect taxi licensing, which is a local authority responsibility, but that doesn’t mean that the cash-strapped local council should assume responsibility for the entire scheme. Local authorities play a key role in the food hygiene system and various parts of the public sector could, or even should, be partners in this.
As ever, the questions that will trouble everyone will be cost and cost effectiveness. Again, I am completely open on this, but in this era of participatory budgets—they're coming to the fore now—this is a scheme that is discreet, easy to explain and easy to understand. So, why notoffer it up as an idea?The principle of pooled budgets and more inter-sectoral collaboration is also the direction in which we’re heading, so there’s less reason now, I think, to say that this must be financed by the central health budget or a local authority budget. There is noreason in principle why the wealthier end of the disabled charity sector can’t contribute to a common budget. Explore all ideas and don’t let the oldfinancial models close down the development of great new ideas.
And then, finally, just with regard tocost-effectiveness, the first thing to point out with this is that this is not areplacement for Disability Discrimination Act 2005compliance. It’s not about enforcement or even the applications of rights. It'sprimarily about information, but even then it's part of somethingbigger. I think interest in this scheme isfurther evidence that society is becoming more accepting, whether consciously or not, of the social model of disability, that disability is a feature of how society is organised, rather thanan impairment that just has to be lived with.
There is no obligation in this system for business owners to do anything with their premises. The scores on the doors are just that: public information. If they result in soft persuasion for businesses to improve their services, which I think they probably would, then Iwouldn’t be advocating that those businesses should be charged for re-assessment, ashappens in the case of food hygiene certificates. Theimprovement itself is a step towards that reorganisation of society.
I seethis scheme being of great value to people without disabilities. When signs become part of the landscape, to the extent that you don’t really notice them perhaps, thenthey have achieved something. It’s like when you cross the Severn bridge and it slowly dawns on you that the road signs aren’t bilingual anymore. You may not be a Welsh speaker, butyour unconscious, unseeing expectation is momentarily challenged, because something that’s usually there oddly isn’t, and that's what I can see happening here: all of us becoming so over-familiar with the expectation of universal accessibility that it jars a little every time we see a poor score.
This is why I support this idea over apps or other sources of direct information to people with disabilities, useful as they are. Because it’s not just about services for people with disabilities; it is a nudge towards thispositive societal change.It's about normalising the expectation of access to all, about it being surprising if buildings are closed off to groups of people with a particular disability, and about this being an everyday consideration for everyone, from the town planner to the architect, from the HR department to the union rep. I think that’s quite a lot of value for money from a few stickers, Cabinet Secretary, and I hope that you will pursue this idea with vigour. Thank you.

Thank you. I call on theCabinet Secretary for Health and Social Services to reply to the debate. Vaughan Gething.

Vaughan Gething AC: Yes. Thank you, Presiding—. [Interruption.] Oh, I'll do this, and I'll not clack around. Thank you, Deputy Presiding Officer, and thank you to the Member for introducing the debate with such a constructive speech. To be fair, this is a consistent approach from Suzy Davies on both of these issues—disability rights and the broader issues around defibrillators. I am aware of the petition that you referred to at the start of your contribution about grading the accessibility of services for disabled people and it's no surprise that it's gained some traction and I look forward to the consideration the Petitions Committee will give to it.
We, of course, want to see all people having equal access to shops, restaurants and other public places. That is something that most of us do take for granted. So, in principle, the idea does have some merit, and I welcome suggestions about practicalities and how such a scheme could work. I think it would be best to keep things as simple as possible so that it's easy to replicate and understand. It may be challenging for a basic numbering system to take account of the wide range of different access issues that would need to be considered, and I recognise what you said about some of the differing challenges of differing forms of disability. But I think it is a proposal to be welcomed and to be thought through, to be properly explored to see how all premises could be as fully accessible as possible.
Of course, there is a challenge, thinking about our current legislative framework from the original Disability Discrimination Act 1995 and now those provisions forming part of the Equality Act 2010. There are provisions made in particular for smaller shops and businesses in older buildings where it may not be possible to make all of the adjustments we would otherwise expect other businesses and premises to make. But, for most, it should be possible to at least make some changes to make their business more welcoming for disabled people. That inclusive approach, with a positive attitude by staff, would benefit all customers, including people with hidden and visible impairments, people with prams, pushchairs, older citizens, and, frankly, people with no disability at all. There is a broader challenge about customer service in a range of the places that we regularly patronise with our custom or, in fact, choose not to because of a customer service experience. That is something that every business should take some time and attention to look at again.
Of course, the environment and services should be designed to be as accessible as possible for all people to the greatest possible extent. And there's something here—and I was pleased to hear the Member recognise this—about the provisions in the Equality Act, but something that does go beyond that and back to the point about customer service that you made in your own contribution, because that isn't simply about complying with legislation, it is about something much more and, actually, for a number of people, about much greater value, where they really feel valued and welcomed when they go in to accessor use a service.
We do need to promote an honest and open discussion—there's a phrase I've heard before, but, an open and honest discussion between disability groups, individuals, the business sector, public service providers and the third sector to understand what we think is required and what we think is possible, whether that’s through a 'scores on the doors' system or by other means, to consider what the options are and what's the best chance of doing something to practically improve accessibility and awareness of it as well. And I was pleased to hear the number of points that you made in your contribution.
You also, of course, referred to defibrillators, a subject that you've mentioned in the past and I'm sure that you'll mention again in the future, whether in a short debate or in questions, moving forward. You'll know that we do have a shared commitment to improving the survival rate for those people who suffer a cardiac arrest in the community. So, the swift use of a defibrillator in tandem with effective CPR and calling 999 as soon as possible offers people the strongest chance of survival. I'm sure I'm not the only person in this room who's undertaken some of that training themselves. My staff have undertaken that training and refresher training as well. It's something that each of us can do to do something practical about that to try and lessen some of the fear, because a point that is regularly made is that,if someone has had a cardiac arrest,you can't hurt them by intervening, because, if you don't intervene, they're not going to be there. There's something here about demystifying. And, actually, for every person who has undertaken training to use a defibrillator, I have been impressed by the fact that it is, 'Oh, it really does tell you what to do'. So, there's something here about taking away some of the concern you understand that people who haven't undertaken that training and had that experience would have.

Vaughan Gething AC: So, there is a greater awareness needed of defibrillators, how to use them, where they're located, and supporting the increased availability of them within our communities, and having them available on the Welsh ambulance service's defibrillator mapping system. I do fully support making life-saving equipment, such as defibrillators, more accessible and having appropriate signage to highlight their locations, and, again, consistency in doing so as well.Of course, these are available not only from commercial organisations, but a range of third sector groups like St John Ambulance, the British Heart Foundation, and a range of other smaller—you know, Welsh Hearts and other charities here in Wales as well.
I'm interested in both the management and the feasibility of having such a system, but I'm open to receiving further information on how we could see such a system working. It's about the practical ability to take forward an entirely reasonable idea.You'll be aware that, last June, I launched theout-of-hospital cardiac arrest plan forWales—another one of our snappy titles in the world of health and government in general. We're in the early stages of trying to implement that plan and deliver real improvements. And so there's a sub-group of the heart conditions implementation group, and they're overseeing progress against objectives in that plan. So, the return of spontaneous circulation is already being implemented—the pathway is being implemented by the Welsh ambulance service and health boards.
Last month, the Welsh Government helped to arrange an implementation workshop, which I was able to attend for part of as well, to try and generate debate on how we deliver the first three rings in the chain of survival: early recognition, early CPR and early defibrillation.Attendees came from a range of cardiac charities, along with representatives from emergency services, and they listened to speakers talking about implementation in Wales and whatwe're already doing, as well as learning lessons from Scotland and also international visitors from Seattle as well. The workshop generated some passionate and informed debate. There's something here about how we corralthe whole sector together to have that debate together and then agree on some national choices. We want to use the energy and the feedback to further implement and improve the plan that we have, using outcomes from the workshop and drawing on that experience from Scotland as well. I am genuinely happy to learn from other parts of the system within the UK that are the most comparable for us here, of course. Work has commenced to develop a detailed implementation plan to support that collaborative approach to increase the access to CPR training and the use of defibrillators.
In addition, we're also establishing a communications group to take forward awareness-raising aspects. They'll look at the issues of awareness of exposure to defibrillators in our communities— again, that point I made earlier about demystifying the use of them. There has been a welcome and significant increase in the number of publicly-available defibrillators that the ambulance service knows about in the last three years. There's a number of campaigns that have helped to do that: Restart a Heart Day, Shoctober, Defibuary are just some of them. Of course, the last two campaigns that I mentioned have led to nearly 13,000 schoolchildren being taught CPR and defibrillator awareness in October last year. I was happy to meet a range of those people in a number of different settings around Wales as part of it.
I'd actually launched the Be a Defib Herocampaign in February 2015, when I was the then Deputy Minister for health, and life was perhaps not simpler but easier in one respect, at least. But since then we've had an additional 396 defibrillators to have been logged and mapped onto the Welsh ambulance service dispatch system. There are currently 3,254 defibrillators in total on the system, and they do allow call handlers to direct callers to the nearest one and the availability in the event of a cardiac arrest. We've already had stories, as a result of that system, of not just more defibrillators being there but actually of lives being saved because those publicly-available defibrillators have been used. And, of course, ambulance staff and volunteers have been working in their local communities on defibrillator acquisition, placement and CPR, resuscitation, training.
Again, in my own constituency, I attended an event in the old Eastern High School, a former pupil whose own life had been saved by the health service, and she's giving lots back, both in undertaking—she's a physiotherapist and a personal trainer who is undertaking work on pulmonary rehab. She's also raised money, and she's providing a defibrillator for her old school, which is going to be placed in the new school that's just been opened.There should, then, be something available both in the publicly-accessible part of the school that'll be available out of hours, as well as within the other side of theschool that is going to be more restricted to in-hours as well. That's a good example of what we know is already taking place in a number of communities around the country.
So, there will need to be time to see the progress that we make with our out-of hospital cardiac arrest plan and to build on the momentum that we do have with stakeholders, charitable organisations, the public sector and, indeed, a range of businesses thatare happy to have their defibrillators mapped on that public system. I hope that Members will engage with and promote the Welsh ambulanceservice's new Defibuary campaign, obviously starting tomorrow, on 1 February, which is easier to say, and the campaign is about raising awareness of early defibrillationand to encourage everyone to find out where their nearest defibrillators are and then to share that on social media.
We do recognise that every one second counts when someone goes into cardiac arrest, so I think all of us will have a shared mission about how we help raise awareness of the importance of early CPR and defibrillation, and, of course, we'll continue to talk about that in this place and to see whether we've made the progress we want to and whether there are other measures that we could take, including—and I know the Member's preference—having a legislative ability to do some of this as well.

Thank you very much, and that brings today's proceedings to a close. Thank you.

The meeting ended at 18:56.

QNR

Questions to the Cabinet Secretary for Education

Lynne Neagle: Will the Cabinet Secretary make a statement on efforts to improve school standards in Torfaen?

Kirsty Williams: Through ‘Education in Wales: Our national mission’ I have set out my priorities for education in Wales. At its heart is a focus on raising standards for all learners, reducing the attainment gap and creating an education system that is a source of national pride and public confidence.

Angela Burns: Will the Cabinet Secretary make a statement on the recent publication of the Estyn Chief Inspector's annual report?

Kirsty Williams: I welcome Estyn’s 2016-17 annual report as further evidence that Wales’s education system is uniting in a mission of self-improvement. I am heartened to see that the chief inspector welcomes the steps we have taken to drive up standards and support improvement in our schools.

Andrew R.T. Davies: Will the Cabinet Secretary make a statement on Welsh Government engagement with local education authorities in Wales?

Kirsty Williams: ‘Education in Wales: Our national mission’ clearly sets out my priorities for education in Wales to raise standards and support all learners to achieve their potential. It also sets out how Welsh Government will work with the other tiers in the system to create an education system of national pride.

Adam Price: Will the Cabinet Secretary outline Welsh Government plans to increase the number of Welsh-domiciled students studying medical education in Wales?

Kirsty Williams: We have been working with both our medical schools to explore how we can increase the number of Welsh-domiciled medical students studying in Wales. In 2016, 25 per cent of the medical students enrolled at Cardiff were from Wales, an increase from 19 per cent in 2015, with similar increases being seen in Swansea.

Russell George: Will the Cabinet Secretary make a statement on how the Welsh Government is seeking to improve educational outcomes for learners in mid-Wales?

Kirsty Williams: The Welsh Government, regional consortia—ERW—and local authorities are collectively supporting schools in mid Wales to improve educational outcomes in line with the priorities in ‘Education in Wales: Our national mission’.

Sian Gwenllian: Will the Cabinet Secretary make a statement on the progress that has been made in relation to the Welsh language Bill?

Kirsty Williams: Progress is being made on the Bill. I published a summary of the responses to the White Paper on 24 January and am now considering the responses carefully before making decisions on the policy direction.

Mandy Jones: Will the Cabinet Secretary make a statement on school reorganisation in North Wales?

Kirsty Williams: Local authorities are responsible for planning school places, taking account of demand for places and the requirements of the modern curriculum. In undertaking their school reorganisation duties they and other proposers must comply with the School Standards and Organisation (Wales) Act 2013 and the school organisation code.

Questions to the Cabinet Secretary for Health and Social Services

Suzy Davies: Will the Cabinet Secretary provide an update on work to improve the resilience of GP out-of-hours services?

Vaughan Gething: Across Wales a range of work is being undertaken to strengthen and develop out-of-hours services. We want to ensure appropriate access and a co-ordinated service to meet the needs of patients. These developments are a priority for the unscheduled care work programme and individual health boards.

Darren Millar: Will the Cabinet Secretary make a statement on the performance of health boards against NHS targets in Wales?

Vaughan Gething: Health boards and trusts in Wales are performing above target in a number of areas and improvements have been seen in a number of other areas. I have made clear my expectations for improvement, especially in areas where we recognise further progress is required.

Lee Waters: What lessons can be learned from the work of NHS Digital and the UK Government's on-line information service in reforming the delivery of the NHS Wales Informatics Service?

Vaughan Gething: Officials will be working with the NHS Wales InformaticsService management board to consider the wider informatics system in Wales. To inform this we will draw on a variety of information, including good practice in other healthcare systems. The recently published Wales Audit Officereport and parliamentary review will also inform this work.

Mark Isherwood: Will the Cabinet Secretary make a statement on progress in implementing the Social Services and Well-being (Wales) Act 2014?

Vaughan Gething: The parliamentary review recognised the 2014 Act as 'a strong foundation to build on'. Implementation of the Act is progressing well across Wales, and we will continue to work with stakeholders to identify and address any areas for further development, informed by the findings of the review.

Rhun ap Iorwerth: Will the Cabinet Secretary make a statement on the Welsh Government's response to the Changing Places campaign?

Vaughan Gething: The provision of accessible toilet facilities is an important issue and certain groups such as older people and disabled people can be particularly affected by poor provision. The Public Health (Wales) Act 2017 places a duty on local authorities in Wales to publish a local toilets strategy for their areas.

Jayne Bryant: Will the Cabinet Secretary make a statement on smear testing in Wales?

Vaughan Gething: Cervical screening can save lives and we want to maximise uptake.Seventy-seven per cent of eligible women in Wales regularly attend for cervical screening. From October 2018 we will be introducing a more sensitive primary test allowing us to more effectively identify women requiring treatment, reducing the need for repeat smears.

Julie Morgan: What plans does the Welsh Government have to improve the health of children in Wales?

Vaughan Gething: We are working to improve child health in Wales through a range of plans and actions. Our programme for government, 'Taking Wales Forward', includes implementation of our Healthy Child Wales programme, a universal health programme for all families with children up to the age of seven.

Mark Isherwood: How is the Welsh Government supporting the recruitment of doctors into the NHS in Wales?

Vaughan Gething: The Welsh Government continues to support local recruitment activity through our successful national and international campaign by marketing Wales as an excellent place for doctors, including general practitioners, to train, work and live.